Skip to main content

Full text of "General therapeutics and materia medica : adapted for a medical text book"

See other formats


THE 

ABNER WELLBORN CALHOUN 

MEDICAL LIBRARY 

1923 




Class. 



BOOK- 






PRESENTED BY 






*a***r.L*. .^ .,. m 



ISt) (jyiye£**~~ 







> 





\ 



<*,. »• 



V£ 



\\ 



GENERAL 



THEKAPEUTICS 



AND 



MATERIA MEDICA; 



ADAPTED FOR A 



MEDICAL TEXT BOOK. 



By ROBLEY DUNGilSON, M. D., 






PROFESSOR OP INSTITUTES OF MEDICINE, ETC., IN JEFFERSlP^THEDICAL COLLEGE OF PHILADELPHIA; 

FORMERLY PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE UNIVERSITIES 

OF VIRGINIA AND MARYLAND, AND IN JEFFERSON MEDICAL COLLEGE 

OF PHILADELPHIA. 



ONE HUNDRED AND EIGHTY-TWO ILLUSTRATIONS. 
FOURTH EDITION, REVISED AND IMPROVED. 

IN TWO VOLUMES. 

VOL. I. 




PHILADELPHIA: 
LEA AND BLANCHARD 

1850. 



Entered, according to Ad^pCongress, in the year one thousand eight 

hundred and forty-two, by 

ROBLEY DUNGLISON, M.D., 

in the Clerk's Office of the District Court for the Eastern District of Pennsylvania. 






KING & BAIRD, PRINTERS, SANSOM STREET, PHILADELPHIA. 



PRE FACE 

TO THE FOURTH EDITION, 



In preparing the present edition, the Author has subjected the work to a 
thorough revision, both as regards its style and matter; and has endeavoured 
to render it a more exact and complete exponent of the existing state of 
knowledge on the important subjects of which it treats. The favour with 
which the former editions were received demanded of him that the present 
should be rendered still more worthy of the patronage of the profession, and 
particularly of the student of medicine, for whose use it was more especially 
destined. With this view, the remedial agents of recent introduction have 
been incorporated in their appropriate places; the number of illustrations 
has been greatly increased; and a copious index of diseases and remedies 
has been appended ; which can scarcely fail to add to the value of the work 
to the therapeutical inquirer. 

When a second edition of his work on General Therapeutics was called 
for by his publishers, the Author deemed it advisable to incorporate with it 
an account of the different articles of the Materia Medica. To this he was 
led by the circumstance, that the departments of General Therapeutics and 
Materia Medica are always associated in the medical schools. In preparing 
the details on the latter department, he did not consider it advisable to go 
farther into the natural and commercial history of drugs than was indispensa- 
ble for the medical student. He would fain hope, that the time may arrive 
when an acquaintance with the different branches of Natural History may be 
esteemed an essential preliminary or accompanying study ; but as the medical 
schools of this continent are constituted, any lengthened investigation of these 
subjects by the Professor would be manifestly impracticable. In the short 
time allotted to a session of medical lectures, there is scarcely opportunity 
afforded to teach that which is indispensable to the therapeutist. 

In all cases, the Author has referred to the position held by the drug as an 
article of the organized, or of the inorganic kingdom ; as well as to general 
matters of interest relative to the place where it is found, .the manner in which 
it is obtained, and to certain points connected with its commercial history ; 
but next to therapeutical applications he has dwelt more at length on the sen- 



IV PREFACE. 

sible properties, by which the physician may be enabled to judge of the vari- 
ous articles from his own observation. In another work,* he has remarked, 
that " it would, doubtless, be well that the physician should know the natural 
history of the animal whence he obtains his castor, his musk, &c, and that he 
should be acquainted with the botanical relations of the plants, whose prepa- 
rations he prescribes ; but such a knowledge is no more indispensable than 
Greek is to an acquaintance with medical technology. The argument may, 
indeed, be extended to the consumer of the products of the animal and vegeta- 
ble kingdoms as articles of diet. It would be well for him, no doubt, to be 
acquainted with the natural history of the ox, the sheep, the hog, &c, whence 
he derives his sustenance ; yet, notwithstanding his ignorance on this point, 
universal experience demonstrates, that he has no difficulty in appropriating 
them to his dietetic necessities." Moreover, there were already valuable works 
in which all these topics, so interesting to the apothecary especially, are given 
at such length as almost to exhaust the subject; and of these one of the most 
remarkable is that of Dr. Pereira, republished in this country under the com- 
petent supervision of Dr. Carson, Professor of Materia Medica in the Philadel- 
phia College of Pharmacy. Of this the Author largely availed himself in the 
preparation of the second edition of the present work. He was likewise greatly 
indebted to the full and accurate Dispensatory of. Drs. Wood and Bache — his 
learned colleagues in the last revision of the Pharmacopoeia of the United States 
(1842) ; to the Dispensatory of Dr. Christison ; and — in a minor degree — to the 
work on Therapeutics and Materia Medica of MM. Trousseau and Pidoux. 
Nor did the modern German publications on the subject escape his attention. 

His great object was to prepare a work on General Therapeutics and Materia 
Medica, which might aid the medical student in acquiring the main results of 
modern observation and reflection ; and, at the same time, be to the practi- 
tioner a trustworthy book of reference. 

The views of General Therapeutics are essentially the same as in the former 
editions. The Author has been pleased to find, that the period which has 
elapsed since their first promulgation, has but strengthened his belief in their 
general accuracy ; so that he has not deemed it necessary to make many or 
great modifications. Throughout, he has adopted the nomenclature of the last 
edition of the Pharmacopoeia of the United States, — a work, which ouoht to 
be in the hands of every practitioner as a guide in the preparation of medi- 
cines; and he has endeavoured to arrange the articles in each division, as nearly 
as he could, in the order of their efficacy as therapeutical agents. 



EOBLEY DUNGLISOxY 

t,} 
April, 1850. 



18 Girard street, ") 



The Medical Student, second edition, p. 161. Philadelphia, 1844. 



EX PROFESSO TREATISES 



ON 



MATERIA MEDICA AND THERAPEUTICS, 



CONSULTED IN THE 



PREPARATION OF THIS EDITION. 



« m » m » 



Aschenbrenner.— Die neueren Arzneimittel unci Arzneibereitungs- 
formen mit vorziiglicher Beriicksichtigung des Bediirfnisses praktischer 
Aerzte bearbeitet, von Dr. M. Aschenbrenner ; und bevorwortet von 
Dr. A. Siebert, 12mo. Erlangen, 1848. 

Ballard and Garrod. — Elements of Materia Medica and Therapeu- 
tics, by Edward Ballard, M. D., and Alfred Baring Garrod, M. D., 
8vo. London, 1845. 

Bouchardat. — Annuaire de Therapeutique, de Matiere Medicale, de 
Pharmacie et de Toxicologie pour 1847, &c, &c, par le Dr. A. Bou- 
chardat, 32mo. Paris, 1847. 

Idem pour 1848.— Paris, 1848. 

Idem pour 1849.— Paris, 1849. 

Carson. — Illustrations of Medical Botany, consisting of coloured 
figures of the Plants affording the important articles of the Materia 
Medica, and descriptive Letter-press, by Joseph Carson, M. D., Pro- 
fessor of Materia Medica in the Philadelphia College of Pharmacy, 
&c, &c, 4to., Philadelphia, 1847. 



v l TREATISES CONSULTED. 

Christison. — A Dispensatory or Commentary on the Pharmacopoeias 
of Great Britain and the United States, by Robert Christison, M. D., 
2d edit., revised and improved, with a supplement, containing the most 
important new remedies, with copious additions, &c, by R. Eglesfeld 
Griffith, M. D., 8vo., Philadelphia, 1848. 

Dierbach. — Die neuesten Entdeckungen in der Materia Medica, fur 
praktische Aerzte geordnet, von Dr. Johann Heinrich Dierbach. Dritter 
Band, erste Abtheilung, 8vo., Heidelberg und Leipzig, 1845. 

Idem. Dritter Band, zweite Abtheilung, Heidelberg und Leipzig, 
1847. 

Griffith. — Medical Botany, or descriptions of the more important 
plants used in Medicine, with their history, properties, and mode o 
administration, by R. Eglesfeld Griffith, M. D., 8vo., Philadelphia, 
1847. 

Griffith. — A Universal Formulary, containing the methods of pre- 
paring and administering officinal and other medicines. The whole 
adapted to Physicians and Pharmaceutists. By R. Eglesfeld Griffith, 
M. D. 8vo., Philadelphia, 1S50. 

Mitscherlich.— Lehrbuch der Arzneimittellehre, von Dr. C. G. 
Mitscherlich, Professor an der Friedrich-Wilhelms-Universitat und an 
der medicinish-chirurgischen Militair-Academie zu Berlin. Erster 
Band, zweite verbesserte Auflage, 8vo., Berlin, 1847. 

Mohr and Redwood. — Practical Pharmacy ; the arrangements, appa- 
ratus and manipulations of the pharmaceutical shop and laboratory, by 
Francis Mohr, Ph. D., and Theophilus Redwood. Edited, with exten- 
sive additions, by William Procter, jr., 8vo., Philadelphia, 1849. 

Oesterlen. — Handbuch der Heilmittellehre, von Dr. F. Oesterlen 
Svo., Tubingen, 1845. 

Pereira. — The Elements of Materia Medica and Therapeutics by 
Jonathan Pereira, M. D., F. R. S., and L. S., 3d edition, vol. 1 Svo. 
London, 1849. 

Plagge. — Handbuch der Pharmakodynamik fur Aerzte Wundarzte 
und Studirende, nach den neuesten Erfahrungen des In und Auslandes 



TREATISES CONSULTED. vii 

wie auch nach eigener dreissigjahriger Erfahrung am Krankenbette : 
kritisch bearbeitet, von Martin Wilhelm Plagge, Med. et Chir. Dr., 
8vo., Braunschweig, 1847. 

Richard. — Elements d'Histoire Naturelle Medicale, contenant des 
Notions generates sur l'Histoire Naturelle, la Description, l'Histoire et 
les Proprietes de tous les Aliments, Medicaments ou Poisons tires des 
Vegetaux et des Animaux, ouvrage orne de 800 gravures intercalees 
dans le texte, par Achille Richard, D. M., Professeur a la Faculte de 
Medecine de Paris, &c, 4eme edit, Paris, 1849. 

Royle. — Materia Medica and Therapeutics; including the prepara- 
tions of the Pharmacopoeias of London, Edinburgh, Dublin, and [ot 
the United States,] with many new Medicines, by J. Forbes Royle, 
M. D., F. R. S. Edited by Joseph Carson, M. D., 8vo., Philadelphia, 

1847. 

Trousseau and Pidoux. — Traite de Therapeutique et de Matiere Me- 
dicale ; 3eme edit., par A. Trousseau et H. Pidoux, M. D., 8vo., Paris, 
1847. 

Wood and Bache. — The Dispensatory of the United States of Ame- 
rica, by Geo. B. Wood, M. D., and Franklin Bache, M. D., 8th edit., 
8vo., Philadelphia, 1849. 



CONTENTS OF VOL. I. 



CHAPTER I. 

GENERAL CONSIDERATIONS. 

Therapeutics defined — Instinctive action of recuperation — Importance of bearing it 
in mind in the treatment of disease — Cure by sympathy — Expectant Medicine — 
Efforts of nature — Crises — Medical experience — Science of medicine demonstrative 
Pre-eminence of therapeutics — Therapeutical indications vary with medical theories 
— Necessity of discovering the pathological lesion — Rational therapeutics founded on 
rigid physiologico-pathological deduction — Importance of discovering the cause of the 
lesion — Etiology obscure — Early medical practice — The Asclepiades — Empirics and 
Dogmatists — French medical school of observation — Numerical methods — Necessity 
for observation and reasoning — Hematology — Importance of principles in Medicine 17 



CHAPTER II. 

CIRCUMSTANCES THAT MODIFY THERAPEUTICAL INDICATIONS. 

Age — Sex — Original conformation — Habit — Climate — Mental affections — Races, Pro- 
fessions, and way of life — Causes, seat, period, &c, of the disease . . .45 

1. Age ......... 45 

2. Sex . . . . . . . .47 

3. Original Conformation ... . . . . 49 

4. Habit ......... 57 

5. Climate ........ 59 

6. Mental Affections . . . . . . .64 

7. Races, Professions, and Way of Life ..... 72 

8. Causes, Seat, Period, &c, of the Disease . . . . .74 

CHAPTER III. 

OP MEDICINES. 

A medicine defined — General action of medicines — Various modes of action — By 
simple, direct or local action — By indirect or general action — Through the nerves — 
Through absorption — Medicines divisible into Excitants and Sedatives — Classifica- 
tion of medicines — Barbier's Classification — A. T. Thomson's Classification — 
Pereira's Classification — Author's Classification . . . . .76 

1. Modus Operandi of Medicines ...... 77 

a. By Simple, Direct, or Local action . : . . .77 

b. By Indirect or General Action . . . . 78 

1. Through the Nerves . . . . . . .78 

2. Through absorption . . . . . .87 

2. Classification of Medicines . . . . • .95 

Vol. I.— 1* 



CONTENTS. 



SECTION I. 

AGENTS THAT AFFECT PROMINENTLY THE ALIMENTARY CANAL OR ITS 

CONTENTS. 

I. Emetics.— Definition of emetics — Nauseants — Their mcdus operandi — Thera- 
peutical application — Physiology of vomiting — Modus operandi of emetics — Effects 
on the stomach, and general system — Evils of their too frequent'employment — Thera- 
peutical application — Special emetics . . . . • .103 

1. Nauseants ........ 104 

Therapeutical application of Nauseants . . . • .105 

II. Emetics ........ 106 

Therapeutical application of Emetics . . • . . .113 

Special emetics . . . . . . . .121 

a. Direct Emetics ........ 121 

b. Indirect Emetics . . . . . . .123 

II. Cathartics. — Definition of cathartics — Effects they are capable of inducing — 
Organs on which they act — Divided into laxatives and purgatives — Drastics — 
Abuse of cathartics — Glysters — Suppositories — Therapeutical application — In fevers 
— In inflammatory disorders — In hemorrhage — In the neuroses — In dropsies, &c. 

— Special cathartics . . . . . . . .140 

Enemata ........ 149 

Suppositories . . . . . . ..151 

Therapeutical application of Cathartics . . . . .151 

Special Cathartics . . . . . . . .161 

I. Laxatives or Mild Cathartics . . . . , .162 

II. Purgatives, or Brisk Cathartics . . . . . .169 

Saline Cathartics . . . . . . .189 

III. Drastic Cathartics . . . . . . . .197 

III. Anthelmintics. — Definition of anthelmintics — Experiments on worms out of 
the body — Different kinds of anthelmintics — True anthelmintics — Mechanical an- 
thelmintics — Anthelmintics that expel worms by acting on the intestinal canal — 
Anthelmintics that prevent the formation of worms — Ectozoa — Special Anthelmintics 210 

1. True Anthelmintics . . . • . . . . 212 

2. Mechanical Anthelmintics ....... 213 

3. Anthelmintics that expel worms by acting on the intestinal canal . 212 

4. Anthelmintics that prevent the formation of worms .... 212 
Special Anthelmintics . . . . . . .214 

I. True Anthelmintics ........ 214 

II. Mechanical Anthelmintics ...... 222 



SECTION II. 

AGENTS THAT AFFECT PROMINENTLY THE RESPIRATORY ORGANS. 



Expectorants. — Definition of expectorants — Organs on which they act Modus 

operandi — Are indirect agents only — Inhalations — Special Expectorants 
Inhalations ........ 

Special Expectorants ...... 

I. Excitant Expectorants ...... 

II. Demulcent Expectorants ..... 

III. Nauseant and Emetic Expectorants . • . 

IV. Topical Expectorants — Inhalations .... 

a. Excitant Inhalations ..... # 

b. Sedative Inhalations ..... 



224 
226 
228 
228 
240 
254 
255 
255 
260 



CONTENTS. XI 

SECTION III. 

AGENTS THAT AFFECT PROMINENTLY THE FOLLICULAR OR GLANDULAR ORGANS. 

I. Errhines. — Definition of errhines. — Sternutatories — Modus operandi — Dangers 

of sneezing — Special Errhines . . . . . . .261 

Therapeutical application of Errhines ..... 262 

Special Errhines . . . . . . . . 264 

II. Sialogogues. — Definition of sialogogues— Their employment limited — Modus 
operandi of sialogogues — Mercury as a sialogogue — Special sialogogues . .266 

Therapeutical application of Sialogogues ..... 266 
Special S'alogogues . . . . . . . .267 

III. Diuretics. — Definition of diuretics — Their modus operandi — Mental diuretics 
— Therapeutical employment of diuretics — In dropsies — In various chronic diseases 

— Special diuretics . . . . * . . . . 269 

Therapeutical application of Diuretics ..... 272 

Special Diuretics . . . . . . . *274 

1. Excitant Diuretics . . . . . . . 274 

II. Sedative Diuretics ........ 286 

IV. Antilithics. — Definition of antilithics, and of lithonthryptics — Calculous dia- 
thesis — Lithic and phosphatic diatheses — Different varieties of calculus — Thera- 
peutical application of antilithics to those varieties — Lithonthryptics — Special 
antilithics . . . ... • • • .291 

J. Antilithics . . . .' . . . .291 

Therapeutical application of Antilithics ..... 294 

2. Lithonthryptics . . . . . . .296 

Special Antilithics . . . . . . . . 298 

1. Acid Antilithics . . . . . . . 298 

2. Alkaline Antilithics . . . . . . .299 

3. Tonic Antilithics . . . . . . .301 

i 

V. Diaphoretics. — Definition of diaphoretics — Largely invoked in Therapeutics — 
Disease not often induced by suppressed perspiration — Modus operandi of diapho- 
retics — Are indirect agents — How their operation may be aided — Their therapeu- 
tical application — Special Diaphoretics . . . . . ■ 305 
Special Diaphoretics . . . . . . . .312 

I. Sedative Diaphoretics . . . . . . .312 

II. Excitant Diaphoretics . . . . . . .316 

III. Topical Diaphoretics . . . . . . .327 

SECTION IV. 

AGENTS THAT AFFECT PROMINENTLY THE NERVOUS SYSTEM. 

I. Narcotics. — Definition of Narcotics — May be used as excitants, and as sedatives 
— Their action elucidated by that of opium — May act locally as well as generally — 
Mental narcotics — Anaesthetics — Therapeutical application of narcotics — In febrile 
diseases — In the phlegmasia, &c. — Special narcotics .... 332 

Therapeutical application of Narcotics ..... 345 

Special Narcotics . . . . . . . . 346 

II. Tetanics. — Definition — Modus operandi — Therapeutical application — Special 
Tetanies . . . . . . . . . 388 

Special Tetanies ........ 389 



XU CONTENTS. 

III. Antispasmodics Definition of antispasmodics — Spasm considered — No direct 

antispasmodic — Modus operandi of indirect mental antispasmodics — Therapeutical 
application of antispasmodics, in tetanus, chorea, epilepsy, asthma, hooping cough, 
colic, hysteria, &c — Special antispasmodics . . • • • ^94 

Therapeutical application of Antispasmodics . 

Special Antispasmodics .....•• 402 

Excitant Antispasmodics .....•• 402 

SECTION V. 

AGENTS THAT AFFECT PROMINENTLY THE ORGANS OF REPRODUCTION. 

I. Emmenagogues. — Definition of emmenagogues — Modus operandi — No direct 
emmenagogues — Special emmenagogues . . . . . .411 

Special Emmenagogues . . . . . . .415 

I. Cathartic Emmenagogues ....... 415 

II. Excitant Emmenagogues ...... 478 

II. Parturifacients. — Definition of parturifacients — Most of them indirect agents 

— often destroy the mother — Aristolochics — Special parturifacients . .423 

Aristolochics . . . . . . . . 425 

Special parturients . . . . . . . .425 

SECTION VI. 

AGENTS THAT AFFECT VARIOUS ORGANS. 

I. Excitants. — Irritation, not debility, the great lethiferous agent — Causes of death 
in cases of extensive abscess, phthisis pulmonalis, &c. Debility in one organ may 
suggest irritation in another — Cases of really diminished action — Division of exci- 
tants — Definition of excitants — Carminatives — Chiefly derived from the vegetable 
kingdom — Simple direct action of excitants — General effect of excitants — Excite- 
ment and collapse defined — *Excitants act also as revulsives — Therapeutical appli- 
cation of excitants — In gastric and intestinal affections — In fevers — In inflammatory 
diseases — catarrhs — In the neuroses, hysteria, epilepsy, paralysis — In topical inflam- 
mation — Mental excitants — Special excitants . . . , .431 
Therapeutical application of Excitants ..... 437 
Special Excitants . . . . . . . 446 



LIST OF ILLUSTRATIONS 



< • • » » 



VOL I. 



FIG. 

1. Cephaelis Ipecacuanha 

2. Brown Ipecacuanha root . 

3. Striated Ipecacuanha root; Un 

dulated Ipecacuanha root 

4. Richardsonia Scabra 

5. Ionidium Ipecacuanha root 

6. Gillenia Stipulacea . 

7. Lobelia Inflata . . 

8. Sinapis Alba . 

9. Sinapis Nigra . 

10. Sanguinaria Canadensis . 

11. Anthemis Nobilis . 

12. Apocynum Androssemifolium 

13. Phytolacca Decandra 

14. Erythronium Americanum 

15. Ficus Carica 

16. Tamarindus Indica . 

17. Ricinus Communis . 

18. Rheum Palmatum . 

19. Rheum Compactum . 

20. Rheum Emodi . 

21. Aloes, various species of . 

22. Aloe Socotorina 

23. Cassia Lanceolata 

24. Cassia Acutifolia 

25. Legume and leaflet of Acute 

leaved Alexandria Senna 

26. Legume and leaflet of C. Obo 

vata .... 

27. Tinnevelly Senna 

28. Cassia Marilandica . 

29. Podophyllum Peltatum . 

30. Ipomaea Purga 

31. Cucumis Colocynthis 

32. Hebradendron Cambogioides 

33. Croton Tiglium 

34. Momordica Elaterium 

35. Momordica Elaterium 

36. Apocynum Cannabinum . 

37. Triosteum Perforatum 

38. Chenopodium Anthelminticum 

39. Spigelia Marilandica 

40. Nephrodium Filix mas . 



PAGE. 


FIG 


. 125 


41. 


. 126 


42. 




43. 


. 127 


44, 


. 127 


46. 


. 128 


47. 


. 130 


48. 


. 132 


49. 


. 133 


50. 


. 133 


51. 


. 136 


52. 


. 137 


53. 


. 138 


54. 


. 138 


55. 


. 139 


56. 


. 166 


57. 


. 167 


58. 


. 169 


59. 


. 171 


60. 


. 171 


61. 


. 172 


62. 


. 176 


63. 


. 176 


64. 


. 180 


65. 


. 180 


66, 


.. 


68. 


. 181 


69. 


- 


70. 


. 181 


71. 


. 181 


72. 


. 184 


73. 


. 185 


74. 


. 198 


75. 


. 200 


76. 


. 201 


77. 


. 204 


78. 


. 206 


79. 


. 207 


80. 


. 209 


81. 


. 209 


82. 


i 216 


83. 


. 216 


84. 


. 218 


85. 



PAGE. 

Punica Granatum . . . 219 

Melia Azedarach . . . 220 

Mucuna Pruriens . . . 222 

45. Inhaling Bottles . . 227 

Polygala Senega . . . 228 

Myroxylon Peruiferum . .231 

Sty rax Officinale . . .233 

Balsamodendron Myrrha . . 237 

Acacia Arabica . . . 241 

Althsea Officinalis . . .242 
Olea Europaea .... 245 

Saccharum Officinarum . . 247 

Glycyrrhiza Glabra . . . 248 

Linum Usitatissimum . . 249 

Astragalus Verus . . . 250 

Cetraria Islandica • . . 252 

Inhaler . . ^ . . .258 

Datura Stramonium . . 260 

Cochlearia Armoracia . .268 

Chimaphila Umbellata . . 277 
Cantharides .... 281 

Leontodon Taraxacum . . 284 

Digitalis Purpurea . . . 287 

Barosma Crenata . . , 301 

67. Cissampelos Pareira . . 303 

Arbutus Uva Ursi . . . 304 

Eupatorium Perfoliatum . .317 

Guaiacum Officinale . . 319 

Daphne Mezereum . . . 322 

Xanthoxylum Fraxineum . 325 

Arum Triphyllum . . . 325 

Carthamus Tinctorius . . 326 
Crocus Sativus .... 326 
Warm-bath .... 330 

Hip-bath 330 

Foot-bath . 331 

Apparatus for smoking opium . 353 

Papaver Somniferum . . 361 

Hyoscyamus Niger . . • 362 

Atropa Belladonna . . . 364 

Conium Maculatum . . 369 

Aconitum Napellus . . . 373 

Humulus Lupulus . • • 377 



XIV 



LIST OF ILLUSTRATIONS. 



FIG. 
86. 

87. 
88. 
89. 
90, 
92. 
93. 
94. 
95. 
96. 



97. 



98. 

99. 
100. 
101. 
102. 
103. 



PAGE. 

Dried Lupulinic grain with its 

hilum (magnified) . . 379 
Cannabis Sativa . . . 379 

Inhaler 383 

Ether Inhaler. . . .384 
91. Chloroform Inhalers. . 387 
Strychnos Nux Vomica . . 389 
Narthex Assafoetida . . 402 
Castor sacs of Castor fiber . 404 
Musk sac ... . 409 
Musk sac, deprived of its hairy 
coat, to show its muscular 

coat 

Musk sac deprived of its hairy 
coat and circular muscular 
fibres ..... 
Vertical section of the musk 
sac in situ . . ... 
Ilelleborus Niger . 
Hedeoma Pulegioides 
Ergotsetia Abortifaciens 
Secale Cornutum . 
Cinnamomum Zeylanicum 



409 



409 

409 
417 
419 
425 
426 
446 



FIG. PAGE. 

104. Coriandrum Sativum . . 450 

105. Elettaria Cardamomum . . 450 

106. Cardamom .... 451 

107. Caryophyllus Aromaticus . 452 

108. Foeniculum Vulgare . . 453 

109. Myristica Moschata . . 45.6 

110. Nutmeg in the shell and sur- 

rounded by the mace . . 457 

111. Citrus Limonum . . . 462 

112. Citrus Aurantium . . . 463 

113. Camphora Ofiicinarum . . 464 

114. Dryabalanops Camphora . 465 

115. Canella Alba . . . .468 

116. Dry mis Winteri . . .469 

117. Calamus .... 470 

118. Piper Nigrum . . . 472 

119. Zingiber Officinale . . ...477 

120. Abies Balsamea . . 4 . 479 

121. Copaifera Langsdorffii . .484 

122. Melaleuca Cajuputi . . 488 

123. Electrical apparatus for medi- 

cal purposes . . .507 



LIST OF ILLUSTRATIONS 



■« — • » > 



VOL. II. 



FIG. 

124. 
125. 
126. 
127. 
128. 
129. 
130. 
131. 
132. 
133. 
134. 
135. 
136. 
137. 
138. 
139. 
140. 
141. 
142. 
143. 
144. 
145. 
146. 
147. 
148. 
149. 
150. 
151. 
152. 
153. 
154. 
155. 

156. 
157. 



PAGE. 

Cocculus Palmatus . . 34 

Cocculus Palmatus . . 35 

Gentiana Lutea . . .36 

Quassia Excelsa . . .38 

Simaruba Amara . . .40 

Frasera Walteri . . .41 
Coptis Trifolia ... 42 

Aristolochia Serpentaria . 46 

Artemisia Absinthium . . 47 

Dorstenia Contrayerva . . 49 

Anthemis Cotula . . .49 

Magnolia Glauca . . .50 

Magnolia Macrophylla . . 50 

Hepatica Americana . . 52 

Indigofera Tinctoria . . 54 

Cinchona Condaminea . . 74 

Cinchona Micrantha . . 77 

Cornus Florida . . 90 

Liriodendron Tulipifera . .91 

iEsculus Hippocastanum . 92 

Acacia Catechu . . .119 

Pterocarpus Marsupium . . 121 

Kramera Triandra . . . 124 

Quercus Pedunculata . . 125 
Hsematoxylon Campechianum 126 

Geranium Maculatum . . 128 

Artanthe Elongata . . .131 

Diospyros Virginiana . . 132 

Heuchera Acerifolia . .133 

Statice Caroliniana . . 135 

Colchicum Autumnale . . 189 

Yeratrum Album. Linn. var. 

Albiflorum .... 194 
Cimicifuga Racemosa . . 196 
Perforated bottom of shower- 
bath 215 



FIG. PAGE. 

158. Shower-bath for children . 215 

159. Abies Excelsa . . .251 

160. Ranunculus Acris . . . 260 

161. Jamaica Sarsaparilla . . 335 

162. Honduras Sarsaparilla . . 335 

163. Aralia Nudicaulis . . . 341 

164. Vitis Vinifera . . .382 

165. Hordeum Distichon ^ j . 283 

166. Hordeum Vulgare . . . 283 

167. Hordeum Hexastichon . . 383 

168. Tacca Pinnatifida . . . 385 
169*. Particles of Tahiti Arrowroot 385 

170. Particles of White East India 

Arrowroot .... 386 

171. Particles of Arrowroot, Pota- 

to-starch, and Tous-les-mois 
as seen through the micro- 
scope on a micrometer, whose 
squares measure one-thou- 
sandth of an inch . . 386 

172. Particles of West India Ar- 

rowroot .... 386 

173. Particles of Tous-les-mois . 387 

174. Particles of Potato-starch seen 

by the microscope . . 387 

175. Janipha Manihot . . . 388 

176. Particles of Tapioca as seen 

' by the microsoope . . 388 

177. Sagus Rumphii . . .388 

178. Particles of Sago meal . . 389 

179. Particles of Potato-sago . . 389 

180. Cycas Revoluta, or the Japan 

Sago-tree .... 389 

181. Avena Sativa . . . .390 

182. Particles of Wheat-starch . 391 



GENERAL THERAPEUTICS 



MATERIA MEDICA. 



CHAPTER L 

GENERAL CONSIDERATIONS. 

Therapeutics defined — Instinctive action of recuperation — Importance of bearing it in mind 
in the treatment of disease — Cure by sympathy — Expectant medicine — Efforts of nature 
— Crises — Medical experience — Science of medicine demonstrative — Pre-eminence of the- 
rapeutics — Therapeutical indications vary with medical theories — Necessity of discovering 
the pathological lesion — Kational therapeutics founded on rigid physiologico-pathological 
deduction — Importance of discovering the cause of the lesion — Etiology obscure — Early 
medical practice — The Asclepiades — Empirics and Dogmatists — French Medical School 
of Observation — Numerical methods — Necessity for observation and reasoning — Hemat- 
ology — Importance of principles in medicine. 

Therapeutics is the branch of Medical Science which comprises the 
doctrine of the management of disease. Generally, however, the term 
is restricted to a description of the modus operandi of medicines; and 
the department is commonly associated, in our Institutions, with Materia 
Medica ; whilst the Practice of Physic is confided to a distinct Profes- 
sor. Under this division, General Therapeutics is made to embrace the 
principles of medicinal administration, and the indications, which the 
different articles of the Materia Medica are capable of fulfilling ; whilst 
the Chair of Practice is appropriated, so far as regards Therapeutics, to 
the application of those principles to particular morbid conditions, or 
to what has been called Special Therapeutics. It is the business of the 
physiologist to investigate the functions of healthy man ; the pathologist 
regards those functions in disease, and the therapeutist endeavours to 
restore them from the latter to the former condition. 

There is no branch of medicine with which the therapeutist ought not 
to be acquainted. To be a good therapeutist requires not only that he 
shall have had extensive opportunities for witnessing disease, but shall 
have read extensively the recorded observations of others. It demands, 
too, the utmost powers of discrimination ; — hence, the varied know- 
ledge, which the physician ought to possess, and the learning and dig- 
nity of the science. 
. Vol. I.— 2 



18 GENERAL CONSIDERATIONS- 

It might be imagined, that lectures on Therapeutics are unnecessary, 
where the mode of managing individual diseases is given from the 
Chair of Practice ; in the latter case, however, the principles are neces- 
sarily diffused— not sufficiently embodied— and, moreover, the teacher 
generally presumes, that the student— which rarely happens— is imbued 
with the great principles and rules, that apply to the administration and 
modus operandi of medicines. 

In the state of health the various functions are executed in a regular 
and harmonious manner, and are intimately connected by consent or 
sympathy ; but if a morbific cause impresses the organism, this harmo- 
nious condition is disturbed; afresh series of actions results, and dis- 
order supervenes. 

Physiologists have noticed in every living body an instinctive action — 
an action of the living principle, whenever manifestly directing its ope- 
rations to the health, preservation, or reproduction of a living frame, or 
of any part of it. This applies to the plant as well as to the animal. 
It is the vis medicatrix natures, for and against which so much has been 
said ; but which — if restricted to the above mentioned acts — can no 
more be denied than the existence of life, of which we know nothing 
except by its results. It is strikingly witnessed in the reparatory power 
exerted by living bodies after the receipt of an injury. If we tear a 
branch from a tree, we find, that the injury done to the parent trunk is 
repaired by an action analogous to that set up by the animal whenever 
a wound is inflicted upon it. In some vegetables, the reparatory power 
is so energetically exerted, that lost parts are restored ; and it is upon 
this power that the utility of certain garden vegetables — spinach, pars- 
ley, cress, &c. — reposes. Such a reparatory power is occasionally — 
but rarely — met with in the animal kingdom. We see it in the lobster 
deprived of its claw, and in the serpent that has lost its tail. The nails 
and hair, too, regain their accustomed length when cut, and the same 
thing happens to the teeth of the Rodentia or gnawers. 

Few animals, however, possess, to any extent, the power of restoring 
lost parts ; but all are capable of repairing injuries, and of removing 
disease when it is within certain limits. In cases of wounds and broken 
bones, the efforts of the surgeon are chiefly restricted to keeping the 
parts in apposition, and to preventing the intrusion of extraneous irri- 
tants, whilst his reliance is placed "on those sanative powers that are 
seated in the wounded part, as in every part of the living frame. It is 
to this power that we ascribe all the properties assigned to the cure by 
sympathy, which, at one time, excited so much attention, was promul- 
gated by the Rosicrucians, and obtained universal credence in the 
seventeenth century. This consisted in applying dressings, in the case 
of wounds, not to the injured parts, but to the weapon that inflicted 
them. The sympathetic powder of Sir Kenelm Digby was an applica- 
tion of this nature, which enjoyed an astonishing reputation. It was 
first employed at Florence, in the commencement of the seventeenth 
century, by a Carmelite monk, who had just returned from India, The 
grand duke, hearing of the monk's marvellous cures, asked him for his 
secret, which he refused, fearing that the duke might divulge it. Some 
time afterwards, Sir Kenelm having rendered an important service to 



GENERAL CONSIDERATIONS. 19 

the monk, the latter, out of gratitude, communicated to him the com- 
position of the powder, and Sir Kenelm took the secret with him to 
England. An opportunity soon occurred for testing its properties. A 
Mr. Howell, having been wounded in attempting to separate two of his 
friends who were engaged in a duel, was subjected to its employment. 
Four days after the infliction of the wound, Sir Kenelm dipped one of 
Mr. Howell's garters in a solution of the powder; and immediately — it 
is asserted — the wound, which was previously painful, became easy ; 
but as the garter grew dry, the pains returned, and were relieved by a 
fresh immersion of the garter in the solution. In fire or six days, the 
wound healed. James the First; his son — afterwards Charles the 
Second; the Duke of Buckingham, and all the principal personages 
about the court, were acquainted with the circumstances of the case ; 
and James — whose enthusiasm was not counterbalanced by much judg- 
ment, and who was, withal, superstitious in the highest degree — obtained 
the secret from Sir Kenelm, and performed most astonishing cures. In 
no great length of time the composition transpired, and, as in all like 
cases, the charm evaporated with the disclosure. 

The powder, employed by Sir Kenelm, is asserted to have been sul- 
phate of copper, prepared in a particular manner. Some affirm that it 
w T as the ordinary green vitriol of commerce. Dryden alludes to the 
superstition more than once in his " Tempest or Enchanted Island" 
Thus, Ariel: 

11 When I was chidden by my mighty lord, 
For my neglect of young Hippolito, 
I went to view his body, and soon found 
His soul was but retired, not sallied out; 
Then I collected 

The best of simples underneath the moon. 
The best of balms, and to the wound applied 
The healing juice of vulnerary herbs. 
His only danger was his loss of blood ; 
But now he's waked, my lord, and just this hour 
He must be dress'd again, as I have done it. 

Anoint the sword, which pierced him, with this weapon salve, and wrap it close 
from air, till I have time to visit him again." 

Act v. scene 2d. 

And : — Miranda, when she enters with Hippolito's sword wrapped up : 

" Hip. O, my wounds pain me ! 

[She unwraps the sword.] 
" Mir. I am come to ease you. 
" Hip. Alas ! I feel the cold air come to me : 
My wound shoots worse than ever. 

[She wipes and anoints the sword.] 
" Mir. Does it still grieve you ? 
" Hip. Now methinks there's something 

Laid just upon it. 
" Mir. Do you find no ease 1 ? 
41 Hip. Yes. Yes : upon the sudden all this pain 

. Is leaving me. — Sweet Heaven, how I am eased !" 

' Act v. scene 2d. 

It is likewise referred to in the third Canto of the " Lay of the Last 
Minstrel," of Sir Walter Scott. 



20 GENERAL CONSIDERATIONS. 

The sympathetic ointments, applied to the weapon, or the " armatory 
unguents," as they were termed, were of various characters, containing 
the most absurd, disgusting, and often inert ingredients. The follow- 
ing extract from the " Sylva Sylvarum" or " Natural History of Lord 
Bacon, strikingly exhibits this. The mode of managing the wound 
sufficiently accounts for the good effects ascribed to the cure by sympa- 
thy. " It is constantly received and avouched, that the anointing of the 
weapon that maketh the wound will heal the wound itself. In this ex- 
periment, upon the relation of men of credit, though myself, as yet, am 
not fully inclined to believe to it, you shall note the points following: 
First, the ointment, with which this is done, is made of divers ingredi- 
ents; whereof the strangest and hardest to come by are the moss upon 
the skull of a dead man unburied, and the fats of a boar and a bear 
killed in the act of generation. These two last I could easily suspect 
to be prescribed as a starting hole, that if the. experiment proved not, it 
might be pretended, that the beasts were not killed in the due time ; for 
as for the moss, it is certain there is great quantity of it in Ireland upon 
slain bodies, laid in heaps unburied. The other ingredients are the 
blood-stone in powder, and some other. things, which seem to have a 
virtue to stanch blood ; as also the moss hath. And the description of 
the whole ointment is to be found in the chymical dispensatory of 
Crollius. Secondly, the same kind of ointment applied to the part itself 
worketh not the effect, but only applied to the weapon. Thirdly, 
which I like well, they do not observe the confecting of the ointment 
under any certain constellation, which commonly is the excuse of ma- 
gical medicines when they fail, that they were not made under a fit 
figure of heaven. Fourthly, it may be applied to the weapon, though 
the party hurt be at a great distance. Fifthly, it seemeth the imagina- 
tion of the party to be cured is not needful to concur ; for it may be 
done without the knowledge of the party wounded ; and thus much has 
been tried, that the ointment, for experiment's sake, hath been wiped 
off the weapon, without the knowledge of the party hurt, and presently 
the party hurt has been in great rage of pain, till the weapon was re- 
anointed. Sixthly, it is affirmed, that if you cannot get the weapon, 
yet if you put an instrument of iron or wood, resembling the weapon, 
into the wound, whereby it bleedeth, the anointing of that instrument 
will serve and work the effect. This I doubt should be a device to 
keep this strange form of cure in request and use, because many times 
you cannot come by the weapon itself. Seventhly, the wound must be 
at first washed clean with white wine, or the party's own water ; and 
then bound up close in fine H?ien, and no more dressing renewed till it 
be whole. Eighthly, the sword itself must be wrapped up close, as far 
as the ointment goeth, that it taketh no wind. Ninthly, the ointment, 
if you wipe it off from the sword and keep it, will serve again, and 
rather increase in virtue than diminish. Tenthly, it will cure in far 
shorter time than ointments of wounds commonly do. Lastly, it will 
cure a beast as well as a man, which I like best of all the rest, because 
it subjecteth the matter to an easy trial." 

The lines in the above quotation, marked in italics, are the key to 
the solution of the whole mystery. It is the practice adopted at the 



GENERAL CONSIDERATIONS. 21 

present day in the treatment of incised wounds, and to this — not 
to the influence of the sympathetic powder, or armatory unguent, it 
need hardly be said — must the main curative agency be ascribed, whilst 
a portion may be assigned (o the mental revulsion produced on the suf- 
ferer, through his faith in the virtues ascribed to the application. The 
wound was carefully defended from the irritation of extraneous sub- 
stances, and given up to that instinctive principle, which, we have seen, 
repairs the injuries to which organized bodies are liable ; and it has 
been suggested, that the results furnished the first hints which led sur- 
geons to the improved practice of healing wounds by what is technically 
called the u first intention." 

The existence, then, of such an instinctive power can neither be denied 
nor lost sight of in the treatment of disease. The error has been, that 
undue weight has been attached to it, so that the practitioner was alto- 
gether guided by its manifestations — or fancied manifestations — : in lay- 
ing down his indications of cure ; and if no such manifestation existed, 
he waited vainly — and too often unfortunately — until the time had per- 
haps gone by for the successful administration of efficacious agents. To 
this system of " waiting or expecting" the term medicina expectans — 
la medecine expectante — was appropriated. The followers of Stahl — 
the great apostle of the doctrine — supposed a power to be present in the 
system of repelling morbific influences, and of re-establishing equilibrium 
when disturbed. There are but few cases, however, in which trust can 
be safely placed in this power. It too often happens, that diseased action 
in a tissue goes on augmenting, until the functions of other tissues be- 
come deranged by extension of morbid action, or by sympathy ; and 
disorganization and death follow. Yet the doctrine of Stahl is still 
maintained by many practitioners— of the old world more especially ; 
and, by some who reject it, terms are frequently employed, which may- 
be regarded as its relics. We often hear, for example, of " efforts of 
nature," yet the ideas attached to the expression are very unprecise. If 
diarrhoea should supervene about the favourable termination of a pro- 
tracted fever, it is looked upon as " critical ;" as a benefice de ventre, or 
a benefice dela nature; but if, on the other hand, diarrhoea supervenes 
in phthisis pulmonalis, as an accompaniment of the hectic fever, proves 
colliquative, and hastens dissolution, we hear nothing of its being an 
effort to disembarrass the economy — or of its constituting a crisis. If, 
again, an individual has suffered under headache, giddiness, and other 
symptoms of encephalic uneasiness, and epistaxis takes place, after which 
the symptoms are removed or mitigated, the hemorrhage is regarded as 
an effort of nature, although it was doubtless dependent upon the same 
pathological condition that gave rise to the headache and the other 
phenomena ; but should the hemorrhage occur to such an extent as to 
excite alarm, or to prove fatal, nothing is said of its being an effort of 
nature. In the same manner, if hemorrhage occurs in the brain or in the 
lungs, we rarely or never hear this mode of accounting for it. 

Yet, although we may discard the notion of efforts of nature, there is no 
doubt, that good occasionally results from spontaneous discharges, and 
that, at other times, their supervention indicates a change in functions 



22 GENERAL CONSIDERATIONS. 

which may have been long disordered and a restoration to the healthy 
condition. Thus, where polyaBmia or plethora exists in the vessels 
generally, or in those of some portion of the economy, the supervention 
of moderate hemorrhage may diminish the intensity of the cause ; and 
diarrhoea, or perspiration supervening on a fever of some duration, in 
which the secretory function has been disordered, may indicate, that 
the organs of secretion are assuming a new condition, and that the 
morbid catenation, previously existing, is beginning to disappear. Al- 
though, then, we may not be justified in regarding such discharges as 
indicating any effort of nature, they may be, and doubtless, frequently 
are, salutary. 

An attention to these topics will lead to the combating of irregulari- 
ties when they occur in the organic actions, provided they are beyond 
the due point ; and, at the same time, teach us not to interfere too much 
with the instinctive actions, provided they seem to be going on favour- 
ably. The therapeutist must be guided, however, by observation and 
reflection as to his rule of conduct in each case. In the very complex 
operations of the animal frame, the relation between cause and effect is 
not always readily appreciable ; great caution is, therefore, necessary on 
the part of the observer, lest, in place of facts — properly so called — he 
should register such as have been termed — not inappropriately — " false." 
Should he incur this error, owing either to the intrinsic difficulty of the 
subject, or to his incompetency as an observer, a foundation may be 
laid for other erroneous observations ; and deductions, and experience 
may thus be acquired ; but such experience may be, in the sequel, most 
unfortunate. The public are, unhappily, too apt to be led away by this 
idea of " experience ;" erroneously believing that all are capable of profit- 
ing by it, and, consequently, that every one who has been sufficiently 
long engaged in the pursuit of his profession must necessarily be expe- 
rienced and wise. Were all men equally attentive, and equally gifted 
with adequate powers of observation and reflection, the deduction would 
be just ; but this is by no means the case. If a man cannot observe and 
reason on topics of a general nature, he cannot on such as appertain to 
medicine ; and, accordingly, the best rule for estimating the abilities of 
the physician by the unprofessional is by examining into the character 
of his mind, his modes of reasoning, his degree of mental application, 
and his general qualifications. _ A man of ordinary mind, application, 
and attainments, may register a few facts ; and by comparing them to- 
gether, may deduce useful inferences so far as these facts may permit, 
and in this way may prescribe sufficiently well in ordinary cases ; but 
such cases are not the touchstone of knowledge. In the multitude of 
trying cases that present themselves to every practitioner in the course 
of his career, what painful anxiety is felt, if he be well informed in his 
profession, and, withal, a philanthropist! What careful comparison of 
his own experience with the recorded experience of others ! What an 
amount of physico-moral reflection before he decides ! Perhaps in no other 
profession or calling are the intellectual and moral faculties so much en- 
listed. But what consolation awaits the physician, if he can feel satisfied 
that the result, at which he has arrived, accords with the just demands 



GENERAL CONSIDERATIONS. 23 

of the case, — that the decision is adequate to the emergency! These 
are cases in which ignorance is bliss, but how fearful the responsibility 
of such ignorance ! 

The curriculum of study, required in the different Medical Colleges, 
has been suggested by a wise care for the lives and the health of the 
public, and such a period of attendance upon the lectures that constitute 
it has been prescribed as may enable the industrious — even if not highly 
gifted— to qualify themselves for entering upon the broad field of obser- 
vation, and of extended usefulness into which their avocation may carry 
them. It is within collegiate walls, that the student acquires the promi- 
nent facts of his profession, and the great principles appertaining to its 
practical administration. He there learns the theory or laws of pheno- 
mena, on which all sound and rational practice is based. Too often, 
amongst the uninformed, the theoretical and the practical pursuit of a call- 
ing are placed in unworthy contrast. In no art can sound practice exist 
without theory. Theory is the mental process which binds observed 
facts or phenomena together ; compares them with each other, and de- 
duces appropriate rules of practice. It is to theory that we are indebted 
not only for full practical usefulness, but for every science. Facts are, 
doubtless, the elements of science, but the science itself does not exist, 
until these facts have been brought together, sifted and compared, and 
great general principles or laws deduced therefrom. 

In such sifting and comparison, a multitude of miscalled facts have to 
be discarded. In the science of medicine — in every science — those that 
merit the epithet false are numerous, and many of them rest on the 
authority of the heedless observer, who arrives at his conclusions with- 
out due examination. The theoretical investigation of science renders* 
a man cautious even to scepticism. Very few, therefore, of the mass of 
recorded facts originate with him : he has little to do in accumulating 
the chaff that envelopes the grain. The records of the Patent Office of 
every country tend to elucidate this matter. It has been properly ob- 
served, that every patent is a speculation. Who, then, are the great 
speculators? Not the theoretical men, in the sense in which we have 
used the term, but what are called practical men, — men, who narrow 
themselves down to observed facts in their own profession or calling, 
and who, in consequence of their ignorance of theory, soon find that 
their inventions are no important additions to existing knowledge. A 
writer on this subject asserts, that he has made a rough estimate of the 
number of scientific persons who have published works relative to new 
inventions in arts, and he finds, that in Europe they did not exceed two 
hundred during the whole of the last century, whilst there are not fewer 
than that number of patents taken out in England annually. An ade- 
quate acquaintance with scientific truths would prevent this waste of 
time and talent ; and hence it is, that a combination of theoretical 
and practical knowledge is necessary to lead to lofty and enduring re- 
sults. This is the great improvement in the modern method of teaching 
the practical sciences. That, which was formerly oracularly delivered 
from the chair as the result of the experience of the master, is not now 
promulgated as indisputable. It is placed before the inquirer as a fact, 
over and over again examined and scrutinized, and the reasons for any 



24 GENERAL CONSIDERATIONS. 

opinion are fairly stated as elements for his decision. The time has 
passed away, when the human mind is to credit the mere verba magistn 
or to place implicit credence in a scientific assertion, without examina- 
tion, because it proceeds from this or that individual. The rule of con- 
duct, implied in the language of the Roman Satirist,— " Marcus dixit, 
ita est"; — 

« Did Marcus say 'twas a fact 1 then fact it is ; 
No proof so valid as a word of his" — 

has been too much inculcated in all ages, and no science has suffered so 
much from it as medicine. It',has been properly remarked by Dr. Aber- 
crombie, in his " Inquiries concerning the intellectual powers and the 
investigation of truth," that in receiving facts on the testimony of others, 
we require to be satisfied not only of the veracity of the narrators, but 
also of their habits as philosophical observers, and of the opportunities, 
which they have had of ascertaining the facts. In receiving affirmed 
truths, therefore, the inquirer has to exercise caution ; but at the same 
time to be careful lest by attempting to avoid one error he may incur 
another, and may pass from credulity to ill-judged scepticism, — ex- 
tremes, which the mind, anxious after truth, will carefully avoid. 

In the management of disease it is not always necessary, that drugs 
should be given, unless their use is clearly indicated ; or unless, in the 
case of certain nervous and impressible individuals, whose faith is not 
reposed in any system of medication, that does not include the use of 
internal medicines. To obtain this faith is an important desideratum, 
as will be seen hereafter, in the treatment of many diseases, of a nervous 
character especially. The physician exhibits his skill better by con- 
trolling disease by appropriate regimen than by administering combina- 
tions of whose effects he often knows little, and where much of his prac- 
tice must necessarily be involved in conjecture. The science of medicine 
is more demonstrative than is usually imagined, and, where the case is 
not so, the practitioner had better for the time do nothing. Any expe- 
riment may have one of two opposite results : it may do good, or harm ; 
and hence, a practitioner is not justified in administering a powerful 
medicinal agent at random. If he be desirous of instituting experi- 
ments, he ought to take example from some modern therapeutical in- 
quirers in Germany, and make them upon himself, rather than upon his 
patients. It cannot often happen, however, that the physician is at a 
loss what course to pursue. His physiological and pathological know- 
ledge will indicate what ought to be the great principles of management ; 
and his acquaintance with the remedial virtues of the different articles 
of the materia medica will suggest the proper agents for carrying those 
principles into action. 

To elucidate this, the case of the drug opium may be taken. It is 
known that it will allay irritation, and produce sleep ; a knowledge 
acquired from observation. It is known also, that in a large dose it is 
sedative ; in a small dose stimulant. When a case of inflammation 
occurs, the physician is not deterred from its use, because it excites in 
a small dose ; but gives it in a quantity sufficiently large to insure the 
sedative operation. Accordingly, observation and reflection have led 



GENERAL CONSIDERATIONS. 25 

to the employment of this useful drug in cases where the practitioner, a 
few years ago, would not have ventured upon it. It is by empirical 
trials, that we become informed of the properties of any medicinal 
agent, after which sound physiological and pathological knowledge sug- 
gests its correct application. 

The great object of the science of.medicine is to remove or assuage 
disease. Hence the pre-eminent importance of Therapeutics. It has 
been largely modified by prevalent systems or doctrines, yet it bends 
less to system than any other branch of medicine ; and, accordingly, 
many of the different sects which have existed from time to time have 
been overthrown by this great test of their validity or weakness. In the 
closet, a consistent scheme may be formed on paper, but when it comes 
to be applied clinically, it may be often found to fail. It is obvious, 
that, cceteris paribus. Therapeutics should be the touchstone of medical 
skill. The number of cures ought to decide the qualifications of the 
practitioner ; but it is so extremely difficult — indeed impossible — to esti- 
mate all the deranging influences ; so many modifying circumstances 
are perpetually occurring, that it cannot be decided that any two cases 
are precisely identical. Hence, we can never judge of the comparative 
success of different practitioners, on which so much stress is placed — 
and placed erroneously — by the public. Owing to these difficulties, 
also, we have such a diversity of sentiment regarding the treatment of 
the same affection. 

Therapeutical indications vary much, however, with medical theo- 
ries. By indication is meant — the end to be had in view in the admi- 
nistration of remedies. For example; in a case of polysemia or over- 
fulness of blood, the indication is obviously to diminish the amount of 
the circulating fluid. These indications have necessarily been greatly influ- 
enced by the views of the dominant medical sect. The humorist or 
humoral pathologist, who looked to the fluids as the cause of all maladies, 
directed his attentions the removal of a fancied acridity, acidity, or 
alkalescency of the humours, or to evacuate them after they had expe- 
rienced a kind of maturation or preparation, which he called concoction; 
whilst the mechanical philosopher attended to the permeability, or the 
contrary, of vessels, — the effects of gravity, and the like ; and his indi- 
cations were based upon his ideas on those matters. But these systems, 
and the Therapeutics founded on them, have passed away; not, how- 
ever, without having left useful mementoes of their existence ; for it is 
obvious, that the conditions which they invoked cannot be wholly dis- 
regarded : the evil with those pathologists was, that they assigned to 
them too prominent a rank in the causation of disease, and that they 
attended to them to the exclusion of more important agencies. 

One of the greatest errors in the investigation of disease, and its mode 
of management, is the belief which long existed, and still exists with 
the mere routine practitioner, that it is only necessary to attend to symp- 
toms or phenomena, and to combat the most prominent as they occur. 
This is obviously insufficient without inquiring into the organ that is 
suffering, and the precise nature of the existing lesion. The same 
symptom may be present in diseases of very different character ; and 



26 GENERAL CONSIDERATIONS. 

before the therapeutist can lay down any satisfactory indications of treat- 
ment, inquiry must be made into these circumstances, as well as to detect 
whether the mischief in the organ be primary or secondary, idiopathic 
or symptomatic ;— in other words, whether the morbid mischief com- 
menced in the main seat of the disease, or began in some other organ 
or tissue, and extended to it by virtue of that correlation, which plays so 
important a part in every physiological, as well as pathological, condi- 
tion of the functions. 

The insufficiency of attending simply to the more prominent symp- 
toms is readily elucidated by a few cases. A feeling of debility is a 
distressing symptom in the most inflammatory, as well as in the most 
enfeebling, disorder ; yet how different the treatment ! _ Itching of the 
glans penis is symptomatic of stone in the bladder. Itching of the nose, 
where the mucous membrane commingles with the skin, occurs in irri- 
tation of the lining membrane of the intestinal canal : in hepatitis, ex- 
cruciating pain is occasionally felt at the top of the shoulder : painful 
retraction of the testis occurs in nephritis ; and intolerance of light and 
sound are distressing symptoms of cephalitis. But it would be extremely 
unphilosophical to attend solely or mainly to those prominent symptoms. 
The primary seat of irritation must be inferred from them, and from far- 
ther attentive examination ; and it is not until the physician has attained 
a thorough knowledge of the seat and nature of the disease, that a 
rational basis can exist for his curative indications. The lesion of the 
affected organ must be appreciated. This is the point of departure for 
an enlightened practice. To resolve this question demands a careful 
inquiry into etiology, as well as into physiological pathology, and not 
until this has been effected can the practitioner properly determine on 
the indications that require fulfilment, and on the mode of fulfilling 
them. 

The fundamental object, in every indication, is to put a stop to or 
mitigate the disorder in the organic actions, and to remove any altera- 
tion that may have supervened in the tissues consequent on such disor- 
der. If inflammation, for example, takes place in any organ, the 
indication is, during the active stage, to remove the particular state of 
vessels concerned in the morbid condition ; and if suppuration, indura- 
tion, or any other of the terminations of inflammation should ensue, to 
have recourse to the appropriate remedies for their removal. When 
once the primary organic lesion is removed, the symptoms occasioned 
by it will disappear; unless, as in the case of the terminations of inflam- 
mation, irritations — which have become independent of the primary 
affection — should persist, and give rise to a special train of symptoms. 
The attention of the therapeutist has, consequently, to be directed, in 
the first instance, to the primary lesion, and afterwards to the secondary 
or symptomatic. 

The nature of the disease, then, or the precise species of vital modi- 
fication of tissue, that gives occasion to the morbid phenomena must 
be the basis of every therapeutical indication ; and although the 
symptoms or manifestations may differ in the different ages and sexes, 
and according to the strength, &c, of the patient, the indications will 
be essentially the same ; and the treatment will rest on the same General 



GENERAL CONSIDERATIONS. 27 

principles, requiring modifications according to circumstances ; but 
these constitute secondary considerations. In inflammation, for ex- 
ample, the general rule must be laid down, that the ordinary anti. 
phlogistic remedies are indicated; and this, whatever may be the 
seat of the inflammation, or the strength, age, habit, &c, of the 
patient; still, many modifications in the treatment may be demanded 
according to these various circumstances. The precise morbid con- 
dition of tissue in inflammation is, at times, extremely difficult of 
detection. To explain this, the case of a blood-shot eye may be taken, 
— a state of the conjunctiva in which several files of red corpuscles 
are forced into vessels, which, in health, admit perhaps but a single file. 
A grain of sand, or some extraneous substance, has excited irritation in 
the conjunctiva, and the consequence has been an afflux of fluids to the 
irritated part. The smaller arteries have taken upon themselves aug- 
mented action ; blood has been sent in undue quantity into the extreme 
vessels, which have become over-distended ; so that, in the case assumed, 
there is an over distended state of extreme vessel, and an over-excited 
state of the artery communicating with it. This is a familiar and strik- 
ing example : it does not, however, apply only to the blood-shot eye, 
but to every case of inflammation. In this state of parts, it is manifest, 
that so long as the extreme vessel remains over-dilated, there will be 
remora of blood in it to a greater or less extent ; the circulation cannot 
proceed as uninterruptedly through it as through a capillary vessel, 
whose coats are in a condition of healthy tone ; owing to this circum- 
stance, excitement is kept up in the vessels immediately communicating 
with the over-distended extreme vessels, which excitement continues so 
long as the over-distension persists, and, in many cases, the irritation is 
extended from the parts first affected to the general sanguiferous system, 
until ultimately the heart and arteries are in a state of excitation and 
turmoil. 

Now, a great difficulty in investigating the pathology of inflammation 
consists in our not always being able to discover whether this atonic 
condition of the extreme vessel, induced by over-distension, or the over- 
excited state of the vessel communicating with it, is the condition which 
more especially requires attention : hence the difficulty of saying, in 
all cases, whether the topical use of astringents or stimulants, or the 
opposite plan of treatment — the soothing— ought to be had recourse 
to. Every practitioner meets with this difficulty, and accordingly, in 
cases of external inflammation, he is often compelled to resort em- 
pirically to one set of applications ; and, if it should not succeed, to the 
other. 

In certain textures of the body, the predominance of over-distension 
of extreme vessel appears to exist, when they labour under inflamma- 
tion, more commonly than in others. This seems to be the case with 
inflammation of the skin and mucous membranes, which belongs to the 
variety of erysipelatous inflammation ; whilst that of the cellular and 
serous membranes is of a more active cast, and may be regarded as 
appertaining to the 'phlegmonous variety. Accordingly, in erysipelas, 
and in some of the inflammations of mucous membranes, remedies are 
occasionally had recourse to, which can rarely be employed in inflam- 



28 GENERAL CONSIDERATIONS. 

mation of the areolar membrane ; for example, in some varieties of 
burn, or erysipelatous inflammation of the skin, stimulating applications 
are found of service ; whilst in others, where the excitement in the 
communicating vessels is great, antiphlogistic agents are demanded. 
Cases of inflammation of the conjunctiva have been recorded, in which 
decided advantage was produced by dropping the essential oil of 
lemons upon the inflamed surface ; and, in most cases of chronic in- 
flammation, the topical application of gentle excitants is found to 
be beneficial : accordingly, after gonorrhoea, which is an inflamma- 
tion of the lining membrane of the urethra, has continued for a long 
period, we attempt to arrest the discharge by astringent excitants, and 
if these are insufficient, the bougie is sometimes passed, to excite, by 
contact, the vessels to their healthy tone ; and in this manner the gleet 
is often got rid of, after it had resisted the continued use of ordinary 
antiphlogistics. In these cases — as in all others — rational treatment 
is founded on rigid physiologico-pathological deductions. 

It is important in every morbid condition to inquire into the cause, 
that may have produced, or is producing, the phenomena. That this 
must be removed, when practicable, is a self-evident indication. The 
maxim, " Tolle causam cessat effectus" although often true, is not 
always so. If a thorn be run into the flesh, irritation exists so long 
as the thorn remains there ; and if it be removed, the recuperative 
powers of the part speedily repair the injury that has been inflicted. 
In like manner, if a decayed or loose tooth be exciting repeated gum- 
boils, the obvious remedy is to remove the tooth. But in the large 
mass of morbid conditions, although the cause, which immediately pro- 
duced the disease, is taken away, the complaint continues. A man, 
from a night's sojourn in a malarious district, may receive a sufficient 
dose of the exciting cause to induce intermittent fever, and although 
he may be removed from the unhealthy locality, the fever will persist 
after his change of residence. It may be said that, in this case, the 
malaria may still be present in the system; and this is possible; but it 
is more probable — more consistent with analogy — that a morbid influ- 
ence is exerted on the economy from such exposure, and that the effects 
go on notwithstanding the abstraction of the morbid cause ; in the same 
manner as a disease, produced by local irregularity of action in the 
capillary system owing to exposure to cold and moisture, may persist, 
notwithstanding the removal of the cause has been complete. There 
is probably, at all times, a greater predisposition in the organism to 
diseased action in some particular organ or tissue than in another ; so 
that if irregularity of organic action be induced in any external part of 
the body, the mischief may not supervene in the part where such 
irregularity exists, but in the organ especially predisposed to assume a 
morbid action, through the extensive sympathy which exists between 
every part of the system of nutrition. Owing to this circumstance, the 
difficulty in discovering the precise cause of a disease is often extreme. 
Fortunately, the discovery is not always a matter of moment, inasmuch 
as the disease usually continues independently of the cause ; and it is 
the disease — the modification in the structure or functions that consti- 
tutes the pathological condition— which we have to combat. In all 



GENERAL CONSIDERATIONS. 1 29 

cases, the patient is anxious to find out, and to suggest, a cause"; and 
the suggestions are frequently of the most unphilosophical character ; 
but although the practitioner may feel this, it is not necessary that he 
should show it. 

Allusion has been made to the influence exerted from time to time by 
dominant medical sects on Therapeutics. Such reminiscences are often 
well adapted for diminishing our pride in what are regarded modern 
improvements, and for inducing us to form a more exalted opinion of 
our brethren in ancient periods. The credit of original conception has, 
indeed, been often awarded for observations and opinions, which had 
been inculcated ages before ; escaped notice, and been subsequently 
re-propounded ; — the ancient and the modern being equally entitled, 
perhaps, to the credit of originators. By such reminiscences we may, 
moreover, be enabled to trace the cojurse of improvements, and to throw 
light upon many practices, which, /although frequently the offspring of 
superstition and credulity, were not without their influence on the pro- 
gress of the science, and, under some form or other, are in active opera- 
tion at the present day. 

A knowledge of the effects of remedial agents must have been 
obtained everywhere in the same manner, — in the infancy of the world 
as in savage and uncultivated nations at the present day. Individual 
experience furnished remedies; accident, in almost all cases, leading to 
a knowledge of their powers over the living economy ; and analogy 
suggesting their application to disease. In no other way than by acci- 
dent could the knowledge, that jalap acts as a cathartic, or that opium 
is possessed of anodyne virtues, have been obtained. Even now, when 
we are possessed of all the lights which the collateral sciences have 
shed upon that of medicine, our experience with a new article of the 
materia medica must be wholly tentative ; but as soon as we acquire an 
acquaintance with its effects on the organism, our physiological and 
pathological knowledge enables us to apply it rationally, with full ad- 
vantage, to the treatment of disease. Until, however, the properties of 
any new drug are known, great caution is necessary in making use of it. 
Camerarius first, and De Candolle afterwards, showed — what is now 
notorious — that there is considerable analogy in the action on the organ- 
ism of vegetables, which resemble each other in their external charac- 
ters or botanical relations; and hence, that the arrangement of .plants 
into natural groups or families is calculated to aid us in estimating the 
alimentary or medical properties of untried vegetables, — a method of 
investigation most useful to those who are shipwrecked on foreign and 
unknown shores, and whose subsistence may have to be derived from 
the vegetable products; and one also of great value to the scientific 
naturalist in his appreciation of the various new plants which he may 
have occasion to examine, as respects their utility in rural economy or 
in medicine. Yet this rule of guidance must not be considered abso- 
lute. The graminece have farinaceous and nutritive seeds ; the labia/ce 
are stomachic and cordial ; the seeds of the umbeJlifercs are tonic and 
stimulant; those of the euphorbiacece acrid and purgative ; the juice of 
the conifercB is resinous ; and the bark of the amentacece astringent and 
febrifuge. Such is the general fact ; but there are some striking excep- 



30 GENERAL CONSIDERATIONS. 

tions:— the deadly conium, for example, is alongside the nutritive and 
innoxious carrot ; the sweet potato touches the acrid jalap ; the bitter 
colocynth may be mistaken, by the eye, for the melon ; the potato is 
amongst the poisonous solanese ; the lolium temulentum, of deleterious 
agency, amongst the cerealia ; and the fatal cherrylaurel is in close rela- 
tionship with the plums and the cherries. 

In the infancy of our art, the number of remedial agents whose vir- 
tues were learned by experience must necessarily have been few ; yet 
we have no record of a period when such agents were not known. 
Experience of particular articles was derived from accidental injuries; 
and, in the origin of the art, surgery was doubtless greatly in advance 
of medicine. Sympathy for suffering incited to exertion, with the 
view of discovering some method of relief; and where sensible agen- 
cies failed, recourse was had to charms, incantations and amulets, sug- 
gested by ignorance and superstition, amongst the rude and barbarous 
nations of the present day, almost as extensively, and confided in as 
implicitly, as in the cradle of mankind. If the patient died, the event 
was ascribed to the will of the gods; if he recovered, — by virtue of 
those instinctive powers which are seated in every organized body-^ 
animal and vegetable — and without which the efforts of the physician 
would be vain, — a case of cure was recorded; but no inquiry was 
made as to the precise agency exerted. To the charm, the incantation, 
1 the amulet, was ascribed the whole result; tradition handed down 
the knowledge of its presumed efficacy, and led to its employment in 
similar cases. Would that we were much more philosophical even in 
the nineteenth centur) r ; for w T e meet with many like cases, that exhibit 
but a slight remove from these conditions of ignorance and barbarism, 
even in people that would start at the idea of being assimilated to the 
benighted of those remote ages, or the scarcely less elevated members 
of a barbarous community of the present day ! 

For a long period of history, even amongst the most enlightened 
nations, there could have been only empirical medicine acquired in 
this manner; and all medical instruction must have consisted in a 
transmission, by tradition, of the knowledge of mechanical means, and 
the properties of remedies, previously employed — as it was conceived 
with success — for the healing of wounds and other injuries, and for 
the removal of disease. Art — rude art — existed ; phenomena were 
observed ; but no one attempted to fathom the laws of phenomena, and 
science was therefore not even generated. Herodotus informs us, that 
the Babylonians, Chaldeans and other nations of antiquity, had no phy- 
sicians. When any one was attacked with disease, he was carried into 
the public thoroughfares, and the passers-by were interrogated whether 
they had suffered under, or witnessed, a similar affection ; and if so, 
they were required to state their experience, and to recommend such 
measures as might seem to them adapted for the removal of the malady. 

The first individuals, who raised themselves above the vulgar, made 
the treatment of disease an object of study, and obtained success by 
practising it, were elevated to the rank of gods. Altars were erected 
to them ; and the priests, from being the oracles of the god whom the 
people desired to consult, became themselves physicians. Hence the 



GENERAL CONSIDERATIONS. 31 

practice of medicine was, for a long period, a part of priestcraft, and 
was taught by the ministers of the altars with many occult and mys- 
terious ceremonies, well calculated to impress the vulgar, and to excite 
a belief in their miraculous powers. 

Such was the history of Asclepios or iEsculapius, and the Asclepiades ; 
and if we advert to the mode in which medicine was practised in the 
temples erected to him, w 7 e can readily comprehend the agencies which 
were concerned in the relief that was so often experienced. In the first 
place, it was the universal belief, that all diseases were emanations from 
the anger of the gods. The gods alone could, consequently, cure 
them; and it was in those sacred places, that iEsculapius manifested 
the evidences of his extraordinary powers. The ceremonies, used to 
propitiate heaven in favour of the sick, varied at different periods. 
They were almost all, however, of a nature to act on the imagination, 
whilst a strict regimen was rigorously inculcated. The entrance to the 
temple was interdicted to all who had not previously undergone purifi- 
cation, — the processes connected with which necessarily tended to 
excite hope in the future, and to inspire the sick with full confidence 
in the revelations about to be made to them. When permitted to 
appear before the idol and present their offerings, they found him sur- 
rounded by so many mysterious symbols, and witnessed the performance 
of so many imposing ceremonies, that their exalted imaginations made 
them regard as infallible every oracle of the god. Most of the temples, 
too, were situated in very salubrious* places ; and within, or around 
them, mineral and often thermal waters flowed. It is, therefore, easy 
to conceive, that the purity of the atmosphere, the change of society 
and scenery experienced by the invalids during their pilgrimage to 
consult the oracle, may have had a powerful influence on all those 
affections that we know to be benefited by similar resources. The pre- 
liminary ceremonies to which they were subjected, and the sacrifices 
which were required of them, contributed still more to the same end. 
In the first instance, the most rigorous abstinence was enjoined. Before 
they could approach the cave of Charonium they were compelled to 
fast several days. At Oropus, in Attica, before consulting the oracle of 
Amphiaraus, they were to abstain from wine for three days, and from 
every kind of nourishment for twenty-four hours. In leading them 
through all the avenues of the temple, the priests detailed to them 
minutely, and mystically, the varied miracles which the god had per- 
formed on their predecessors, whose votive offerings and inscriptions 
they had preserved ; and dwelt especially on those cases that resembled 
theirs. 

After these promenades, carefully adapted, in regard to extent, to the 
powers of the invalid, sacrifices were offered to the divinity, with fervent 
prayers to obtain from him the revelation, which was not communi- 
cated, however, until the patient had been bathed, rubbed, and sub- 
jected to various manipulations well calculated to excite a new action 
in the nervous system, and, through it, in the whole system of nutrition. 
They were subjected, too, to fumigations before hearing the answers of 
the oracle ; went through a process of preparation by prayer ; slept in 
the neighbourhood of the temple on the skin of a ram, which had been 



32 GENERAL CONSIDERATIONS. 

offered up as a sacrifice, or by the side of the statue of the g°d>— 
expecting, as they were taught to believe, the appearance before them 
of the God of Health. Can we be surprised, that under such circum- 
stances the excited imaginations of the nervous more especially might 
lead them to fancy, and to credit, that the revelation of future events 
was actually made to them ; or that, in their dreams, they might believe 
that they saw jEsculapius present himself before them, and instruct 
them as to the means to be employed for their cure! 

The remedies advised in their dreams or revealed to them by the 
priests, who were always the interpreters of the dreams, were usually 
of a kind calculated to do neither harm nor good,— such, for example, 
as gentle cathartics prepared of stewed currants, diet easy of digestion, 
or fasting and bathing, accompanied by various mystic ceremonies. 
Yet occasionally they were of a more violent character. Aristides — we 
are told — was the dupe and victim of the Asclepiades for ten successive 
years. He was alternatively purged, vomited and blistered ; made to 
walk barefoot under a burning sun in summer, and in winter doomed 
to seek for the return of health by bathing his feeble and emaciated 
body in the river. All this severity of treatment, he was made to be- 
lieve, was exercised towards him by the express directions of iEscula- 
pius himself, with whom he was persuaded to fancy that he held con- 
verse in his dreams, and frequently beheld in nocturnal visions. On 
one occasion, the god, fatigued by the importunities of Aristides, 
ordered him to lose one hundrefT and twenty pounds of blood, which 
he very judiciously took the liberty of declining! 

After his recovery, the patient rendered thanks to the god, and carried 
him offerings ; and, not unfrequently, the parts that had been the seat 
of the affection were modeled in ivory, gold, silver or other metal, — a 
species of votive offering, which was termed anathema, and numbers of 
which were preserved in the temples. Of one of these votive tablets, 
discovered in the Isle of the Tiber, and published by Gruter, the follow- 
ing is a translation :> — 

" A blind soldier, named Valerius Aper, having consulted the oracle, 
received for answer, that he ought to mix the blood of a w T hite cock with 
honey, and make an ointment to rub the eyes with for three days. He 
recovered his sight, and returned thanks to the god in the presence of 
the people." 

The exclusive exercise of medicine was confirmed to the priests by 
other regulations. As soon as a valuable remedy or preparation was 
discovered, its composition and mode of preparation were inscribed on 
the gates and columns of the temple. The inventors of surgical instru- 
ments also deposited a specimen: and we can thus understand that 
useful isolated facts might be collected by competent individuals into a 
consistent whole ; and there is great reason for the belief, that the father 
of physic was largely indebted to the votive tablets preserved in the 
temple at Cos, in the preparation of his immortal works. 

The custom of hanging up votive tablets in the temple of the patron 
saint, after escape from danger of various kinds, has been known in all 
ages ; and still prevails in certain parts of the world. According to 
Scandinavian mythology, the supreme god, Odin or Woden— whence 



GENERAL CONSIDERATIONS. 33 

our Wednesday, Woden's day — assumes $ie name of Nicker, when he 
acts as the destructive or evil principle ; hence, perhaps, our term Old 
Nick, as applied to the evil one. In this character he inhabits the lakes 
and rivers of Scandinavia, where he raises sudden storms and tempests, 
and leads men into destruction. In short, he is the northern Neptune, 
or some subordinate sea-god of noxious disposition. Nicker, wiffi the 
Scandinavians, being an-t>bject of dread, propitiatory worship was offered 
up to him ; and hence it has been imagined, that the Scandinavian Nicker 
became, in the middle ages, St. Nicholas, the patron of sailors, whose 
aid is still invoked in storms and tempests, — a supposition which re- 
ceives countenance from the devotion still felt by the Gothic nations 
towards St. Nicholas. To this saint many churches on the sea shores 
are dedicated, and many a prayer to St. Nicholas is still offered up by 
the seamen passing by. To these churches, in many countries, sailors, 
who have suffered shipwreck, resort to return thanks for their preserva- 
tion, and to hang up votive tablets representing the dangers they have 
escaped, in gratitude to the saint for the protection he vouchsafed them, 
and in the fulfilment of vows, made in the height of the storm. This 
custom, which is more especially in use in catholic countries, is proba- 
bly taken immediately from the ancient Romans, who had it among a 
number of superstitions from the Greeks; for we are told, that Bion, the 
philosopher, was shown several of these votive pictures hung up in a 
temple of Neptune near the sea-side ; and the custom is referred to by 
Horace. 

Such was the condition of medical observation in the then enlightened 
Greece ; — confined to the priesthood, and full of mystery to the unini- 
tiated, but leading to a knowledge of numerous remedial agencies ; for 
there is every reason to believe, that in the earliest periods the apcients 
had a knowledge of several of our most active remedies, — hellebore, 
opium, and squill for example. Blood-letting, too— as we have seen — 
was employed amongst them. We are told, — and it is the earliest record 
of the operation, — that Podalirius — one of the sons of iEsculapius — on 
his return from Troy, was cast ashore on the Isle of Scyros, where he 
landed, however, in safety; and was taken by a shepherd to the court 
of King Damoethus. Here, he gave proofs of his medical skill, by curing 
the daughter of Damoethus — Syrna — of the effects of a fall, by bleeding 
her in both arms, after her life had been despaired of. In those remote 
periods — as is too much the case even at present — extensive virtues 
were assigned to agencies, often of the most inert kind, which frequently 
obtained the credit of cures, that had been effected by the jugglery of 
the pagan priests, but partly also by the excellent hygienic rules to which 
the patient was subjected. At one time, almost the whole of the materia 
medica consisted of the machinery of magic. Absurd and unmeaning 
words scrawled on parchment ; "figures of idols suspended round the 
neck, were considered to be capable of curing ague; hemorrhage was 
arrested by charms, and even luxations were said to have been reduced 
by barbarous expressions and magical songs ; and we can understand 
that Cato, the Censor, may — as was affirmed — have succeeded in this 
manner ; or, in other words, by distracting the attention of the patient 
by those ceremonies, and seizing his opportunities for such manipula- 

Vol. I.-3 



34 GENERAL CONSIDERATIONS. 

tions as might be needed, hejnay have effected the redaction of a lux- 
ated limb. To imagine, however, that he appreciated the modus ope- 
randi of such ceremonies would be to suppose that he far exceeded in 
intelligence his contemporaries, and successors for ages. ±-ven now— 
when education has been so extensively diffused— faith is still placed in 
the protecting power of the amulet ; and constantly in the author s at- 
tendance on an extensive eleemosynary institution, when it was found 
important to employ physical diagnosis in chest diseases, he has noticed 
the protecting amulet worn close to the heart, and as profoundly che- 
rished, and as much faith reposed in its prophylactic virtues, as in the 
classic periods to which reference has been made. Nay, it is not long 
since there might be seen advertised in an English newspaper— for the 
sum of thirty-five dollars— a caul, to be worn by one going to sea, to 
protect him from shipwreck ; this caul being the foetal membranes,— 
where the child had been born with them unbroken — dried, and worn 
by the mariner, — it being supposed, that if the child survived in the 
midst of the waters, the membranes might likewise prevent him who 
wore them from being drowned ! 

Prior to the age of Hippocrates, no science of medicine existed. 
The priests obtained from the votive tablets records of cases and of 
reputed cures ; but we have no evidence, that any attention had been 
paid to the relation between the symptoms and causes and the mor- 
bid condition. Pathology, in other words, was unknown. Hippo- 
crates first endeavoured to establish the relation between the various 
facts observed by him and his predecessors, and to deduce theory or 
general principles therefrom : hence, he has been commonly regarded 
as the father of the rational or dogmatical system of medicine, as it was 
then called. Others refer this sect to Draco and Thessalus, sons of 
Hippocrates, and to Polybus, his son-in-law ; but their illustrious ances- 
tor is doubtless entitled to the paternity. 

"Although," as Dr. Bostock has remarked, "we can have no hesi- 
tation in pronouncing this to be the correct and legitimate method of 
pursuing the study of medicine, yet it must be acknowledged at the 
same time, that it is a method, which, if not carefully watched, and 
strictly guarded by prudence and sagacity, is exposed to the greatest 
danger of being corrupted by ignorance and presumption. Hence, we 
may easily conceive, that it would be liable to fall into the grossest 
errors, and to lie open to the most serious imputations, and that a fair 
plea would always be found for exclaiming against the introduction of 
what is termed theory into the practice of medicine." Thus it was of 
old : the philosophical principles of Plato and of Aristotle were amal- 
gamated into the systems of medicine, — nay, formed their very bases ; 
experience and observation were rejected, and useless subtleties, which 
to us at the present day are unintelligible, occupied the attention of the 
physician. 

The absurdities, thus engendered, gave rise, in no great length of 
time, to a complete revolution, and to the formation of a new sect 
utterly opposed to the dogmatists, of which Serapion, of Alexandria, 
was the founder. This occurred shortly after the establishment of the 
Alexandrian school. Serapion had many followers among the ancients 



GENERAL CONSIDER ATI ONS. 35 

who were distinguished for their abilities, and were termed Empirics, 
Two rival sects then usurped the domain of medicine — the Dogmatical 
or Rational, and the Empirical. , 

As the Dogmatists rejected all experience and observation, so the 
Empirics held, that the philosophy of the time was foreign to the art of 
medicine, and that all sound experience must be the result of observa- 
tion alone. It was deemed unnecessary to inquire into the etiology or 
causes of disease, except as regarded such as were evident ; anatomy 
was discarded ; and the dissection of bodies with the view of detecting 
the nature of disease was contemned : in short', nothing but the evidence 
of the senses was admitted as the basis of medical knowledge. 

To the latter of these sects, that of the Empirics, which long continued 
to include all the members of the profession, belonged the learned and 
classic Celsus. He manifestly, at least, favours the views which the 
Empirics adopted. Still, his remarks, after a brief consideration of the 
doctrines of the two sects, are such as every enlightened physician of 
the present day would be willing to adopt ; — that the true rule of prac- 
tice must be deduced from a proper combination of reason and experi- 
ence ; — that without experience all preconceived theory would be vain 
and useless, and that by simple experience, without any attempt at gen- 
eralization, we should frequently fall into gross errors, and be unable to 
profit even from the best experience. It is difficult, indeed, to imagine 
how either sect could be able to confine itself rigidly within the rules 
of its own doctrines. As at the present day, there must always have 
been dogmatists, who could not consent to reject all observation, and 
empirics who felt constrained to theorize. 

The Dogmatical and the Empirical were ancient sects ; but in all 
ages, from the periods, to which allusion has been made, downwards, 
there have been physicians, who pretended to be guided solely by a 
rigid attention to observation, and others who indulged in the wildest 
and most visionary hypotheses, despising all observation : at the present 
day, however, few would admit, that they reject either reasoning or 
observation ; and it may be safely affirmed that those few are unfit for 
the practical exercise of their elevated calling. 

The closest approximation to the ancient sect of Empirics, is the 
modern French School of Observation. " This school," says a recent 
American writer, and able supporter, Dr. Bartlett, ** is characterised by 
its strict adherence to the study and analysis of morbid phenomena and 
their relationships ; by the accuracy, the positiveness, and the minute 
detail, which it has carried into this study and analysis ; and by its rejec- 
tion, as an essential or legitimate element of science, of all a priori 
reasoning or speculation. The spirit which animates, and guides, and 
moves it, is expressed in the saying of Rousseau, ' that all science is 
in the facts or phenomena of nature and their relationships, and not in 
the mind of man, which discovers and interprets them.' It is the true 
protestant school of medicine. It either rejects as apocryphal, or holds as 
of no binding authority, all the traditions of the fathers, — unless they 
are sustained and sanctioned by its own experience. It appeals in all 
things directly to nature, and it asks — not what may be 9 or what ought 
to bet but what is? — not how things are? or why they are ? but again 



36 (Seneral considerations. 

what they^re? Holding that medical, as well as all other, science, 
should have but one aim and object, to ascertain the actual constitution 
of things,— it professes an entire scientific indifference as to the issue, 
and result of its researches, provided only that this issue and result 
approach, in the nearest possible degree, to the absolute truth ; and it 
adopts and pursues what it conceives to be the only method and means 
of accomplishing this end." 

Yet schools of this kind have existed in all times, and, from the first 
moment that a medicinal agent was prescribed to the present day, phy- 
sicians have professed to be observers and " to have but one aim and 
object, to ascertain the actual constitution of things." Of the myriads 
of remedies brought forward, and too often with exaggerated preten- 
sions, we should scarcely be justified in affirming, that a single one was 
extolled without the propounder having satisfied himself that such was 
" the actual constitution of things ;" and if it be admitted that a large 
mass of the recorded "facts," as they have been termed, have been 
badly observed, it must be equally admitted, that they were accredited 
results of positive observation ; and, therefore, not to be disregarded on 
light grounds by a school, which professes to be a school of observa- 
tion, par excellence^ — "the true protestant school of medicine, which 
either rejects as apocryphal or holds as of no binding authority, all the 
traditions of the fathers, unless they are sustained by its own experience." 

The distinguished head of this modern school, if it may be so termed 
— -the indefatigable and philosophical Louis — would scarcely, however, 
arrogate so much to himself and his system. To borrow his own lan- 
guage. — " It has been acknowledged, from time immemorial, that medi- 
cine is a science of observation ; nay, it has been said, that it consisted 
solely in observation, — that is to say, it has been allowed, that nothing 
can be done in medicine save by means of well-observed facts:" — 
and the causes to which he attributes the imperfection of medical science 
are, " on the one hand, imperfect observation, and on the other, the habit 
of making analyses, which are incomplete or dependent upon facts 
entrusted to the memory." 

The great, the crowning merit of M. Louis has consisted in urging, 
and carrying into effect, with a tact, industry and talent worthy of all 
commendation, and for which he deserves the gratitude of the profession, 
an improved system of analysis by the employment of numbers or the 
calculation of probabilities applied to medicine. To this numerical 
method the generic name Statistique Medicate has been given by cer- 
tain of the French writers. Originally, the word statistics meant the 
science of states, from the German S t a at ; but by an extension of signi- 
fication by no means uncommon, a term, which was originally applied 
only to states, came to be extended so as to comprise, as at the present 

day, in its signification, the " numeral or numerical method" that is 

numbers employed for the elucidation of any of the sciences of observa- 
tion ; — and the term " medical statistics" is now as well understood as 
" medical jurisprudence." 

The employment of numbers as a means of comparison is by no 
means new ; yet, in consequence of the term "statistics" being of mo- 
dern origin, it has been presumed by many, that numerical methods were 



GENERAL CONSIDERATIONS. 37 

unknown until very recent periods. They have, however, long been 
used in other branches of science, and their non-employment in medi- 
cine, until of late, only shows, that our science has profited but little by 
the example of the more perfect sciences. 

Impressed with the imperfect methods of observation that had previ- 
ously existed, and were still existing, M. Louis proposed to introduce, 
as far as possible, the same mode of exact estimation as had been 
practised in chemistry, for example. " Doubtless," he observes, "this 
department of learning had many learned men among its votaries pre- 
vious to the last forty years ; nevertheless, it is only within this last 
period that chemistry has made rapid progress. What means has it 
employed of late, which were not used before ? It has demanded exact- 
ness; it has weighed and counted always when it was able to do so. It 
has taken rigid notice of every thing which had any bearing upon a 
question. It has substituted a strict analysis for an imperfect and careless 
one. Its methods have been daily more and more precise, and its 
progress is rapid and constant. The same cause, which kept chemistry 
so long in its infancy — the want of rigid method — has weighed upon 
the destiny of medicine, and prevented its growth." 

Much has been written, of late years, against the practicability of 
employing numbers or of counting in medicine, notwithstanding the 
valuable and precise information that has been afforded for ages — even 
from the time of Ulpian — in regard to the laws that govern the move- 
ment of the population, the calculation of probabilities as to the average 
duration of life, and, at a later period, as a guide to the insurance of 
lives, &c, &c. What are these but the application of numbers to eluci- 
date the science of life ! The nearest approximation to the truth, in 
regard to facts or observed phenomena, must obviously be deduced in 
this manner. It is the only accurate mode in which averages can be 
taken. Every practitioner, in all periods of history, has endeavoured to 
carry in his recollection the precise difference, which he notices from 
day to day, in the condition of his patient ; but this course must be far 
inferior to the record, that he daily makes approximately by numbers, 
from which he can deduce his averages. " Averages,"- — as an able 
writer, Dr. Henry Holland, has observed, — " may, in some sort, be 
termed the mathematics of medical science. It is obvious, indeed, that 
the value of inferences thus obtained depends on the exact estimate of 
what are the same facts, — what merely connected by resemblance or 
partial analogy. Pathological results, essentially different, may be 
classed together by inexact observers, or by separate observers under 
different views. These, however, are errors incident to every human 
pursuit, and best corrected by numerous and repeated averages. The 
principle in question is, indeed, singularly effectual in obviating the 
difficulties of evidence already noticed, and the success with which it 
has been employed of late by many eminent observers affords assur- 
ance of the results that may hereafter be expected from this source. 
Through medical statistics lies the most secure path into the philosophy 
of medicine." 

It will not be contested by any one, that facts must be accurately 
observed before they can be made the basis of calculation. It is 



38 GENERAL CONSIDERATIONS. 

clear, too, that averages deduced from a small number of observations 
may lead us into error. Tables of insurance of lives, calculated trom 
the observation of one or two years, would certainly be fallacious ; but 
all experience teaches that those drawn from the calculation ot a long 
series of years lead to satisfactory results. 

The numerical method is, however, more applicable to phenomena 
presented by the healthy or diseased economy than to therapeutics or 
the treatment of disease, which, after all, is the end and aim of all our 
studies. It is, confessedly, the most difficult of the departments of 
medical science, because in it is concentred, or ought to be concentred, 
a knowledge of every other ; and, moreover, it requires— contrary to 
what has been affirmed by the Empirics— not simply observation, but 
the constant use of reason, to rectify the erroneous impressions, which 
imperfect observation, — imperfect, that is without it, — so often occa- 
sions. A glance at the history of medicine exhibits, that the science 
has suffered more from faulty observation than from faulty theories. It 
will generally, indeed, be found, that theories have been based upon 
fancied observation. " From the manner," — says Dr. John Gregory, 
— "in which empirics in all ages, have conducted themselves, it 
is not surprising, that their writings have tended so little to the ad- 
vancement of the art ; and that, on the contrary, they have had 
the greatest share in encumbering it with the many falsehoods 
under which it has labored so long, particularly that important 
branch which relates to the effect of medicines. It has been pre- 
tended, that such empirical books as I have alluded to may be 
useful to those who are not bred to the profession, and who wish 
only to acquire some knowledge of the practical part of physic. Bat 
this is so far from being the case, that these are the only people to whom 
such books are dangerous. A physician of real knowledge and practice 
may draw instruction, or catch hints, from facts related in an imperfect 
manner, which will either be useless, or tend to mislead others who 
have not these advantages. To such, all the circumstances relating to 
the exhibition of a remedy can never be too distinctly specified." 

It is easier, however, to observe than to think, and hence the number 
of useful, but not necessarily scientific, pioneers of science, who restrict 
their attention mainly to the contemplation and classification of morbid 
results, without reflecting whether, or in what manner, they may lead 
to the saving of life or the alleviation of suffering, — without seeming to 
give a thought, indeed, to these all-important results. Such individuals 
would carry the science of medicine back to those periods when the 
ancient empirics " saw without discerning, administered without discri- 
minating, and concluded without reasoning." The mere observer of 
phenomena, who. thinks not, is but the unenviable counterpart of him, 
who 

" Saw with his own eyes the moon was round, 
Was also certain that the earth was square ; 
Because he had journey'd fifty miles, and found 
No sign that it was circular any where." 

On the occasion of almost every introductory lecture to his class the 
author has dwelt upon the heresy of trusting implicitly to simple observa- 



GENERAL CONSIDERATIONS. 39 

tion, and of merely registering the prominent result ; and he has strongly 
urged a wise combination of dogmatism or rationalism with empiri- 
cism — to employ the language of the ancients — before we feel ourselves 
justified in recording our facts as guides for future action. That a 
patient has died, or recovered, may be self-evident, and the fact may 
furnish a datum for the calculations of the medical statistician ; but a 
knowledge of the precise agency of the different remedies employed in 
any case may demand an intimate acquaintance with the physiological, 
pathological and therapeutical bearings of the subject, and withal no 
little power of discrimination on the part of the practitioner. A case or 
two, placed upon record by distinguished members of the profession, 
will illustrate more strikingly, by example, the essential difference be- 
tween the information which simple observation might suggest ; and 
that which would flow from observation conjoined with rational inquiry. 

In the next chapter the author has alluded to a well-known case, narra- 
ted by Dr. Paris in his life of Sir Humphry Davy, in which Dr. Beddoes 
and Davy were about to try the effects of the inhalation of nitrous oxide 
gas for the removal of palsy, but having inserted a thermometer in the 
man's mouth, and the patient believing that the thermometer was the 
curative agent, and saying that he felt something better, it was deter- 
mined to administer no gas, but to repeat the application of the ther- 
mometer, and to trust to it alone : this was accordingly done daily 
for a fortnight, and at the end of the time he was dismissed cured. 

Now, in this case, mere empirical observation w 7 ould have led to the 
record, that the thermometer under the tongue cured a case of palsy. 
But the rational therapeutist is not satisfied with a knowledge of the fact, 
that the disease disappeared after the use of the thermometer. He 
does not record, that the thermometer is " good" — a common expres- 
sion — in palsy ; but ponders on the mode in which the result was pro- 
bably induced ; and he is not long in discovering, that the instrument, 
in such case, must be classed with those agents, that produce their 
effects by the new impressions which they make on the nervous system 
through the external senses. 

Another familiar illustration may be given. It is related, for an ana- 
logous purpose, by Dr. Moore, the distinguished author of Zeluco. The 
story is the prototype of many similar anecdotes that have been told 
since, and it is not an overdrawn picture of the mode in which experi- 
ence must have been registered in days of yore ; nor is it without its 
application at the present day, especially to those who, without the 
observing and logical mind of Louis, consider themselves followers of his 
system, and rigid recorders of observed results — " sustained and sanc- 
tioned by their own experience" — in their view, the only test of truth. 

"A French Student of Medicine," says Dr. Moore, " lodged in the 
same house in London with a man in fever. This poor man was con- 
tinually teazed by the nurse to drink, though he nauseated the insipid 
liquids that were presented to him. At last, when she was more im- 
portunate than usual, he whispered in her ear : — ' for God's sake bring 
me a salt herring, and I will drink as much as you please !' The woman 
indulged him in his request, he devoured the herring, drank plentifully, 



40 



GENERAL CONSIDERATIONS. 



underwent a copious perspiration, and recovered. The French student 
inserted this aphorism in his journal: — 'A salt herring cures an English- 
man in his fever.' On his return to France, he prescribed the same 
remedy to the first patient in fever to whom he was called. The patient 
died, on which the student inserted in his journal the following caveat : — 
' N. B.— -Though a salt herring cures an Englishman, it kills a French- 
man.' " — And these were good honest examples of simple observation, 
of pure empiricism ! 

A just appreciation of the effects of therapeutical agents, and the 
determination of their action, whatever that may be, are properly regarded 
by M. Louis as the most important, and, at the same time, the most 
difficult parts of the method of observing. So many disturbing influ- 
ences have, indeed, to be borne in mind in the estimate, that the inquiry 
has appeared to some to transcend the powers of the human mind. 
M We must compare together," — says that distinguished observer, — " a 
great number of cases of the same disease of equal severity ; some relat- 
ing to subjects in whom the disease was left to itself; others of indi- 
viduals to whom certain medicines were given. After doing this, we 
must study the action of the same therapeutical agent on those in whom 
the disease was severe, and on those in whom it was slight — on those 
in whom the remedy has been used in large or small doses, at a period 
near to, or remote from, the commencement of the disease. This last 
circumstance is very important. So likewise we must mention, whether 
the medicine is used alone, or in conjunction with other medicines. But 
not only does this method require much labour, it supposes also a con- 
siderable series of facts, the connexion of which is difficult, — especially 
when treating severe affections, in which we are accustomed to make 
frequently new attempts, and which will not allow of our remaining a 
mere spectator of the progress of the disease. For it must be evident, 
that we do not seek to know, by approximation, what remedies have 
appeared to be more or less successful, but to demonstrate, in a rigorous 
manner, that a certain remedy, or certain method, is useful or hurtful, 
and in different degrees, according to the manner in which we em- 
ploy it." 

The necessity for such repeated observations to enable us to make 
any accurate estimate of therapeutical agencies has been felt and appre- 
ciated by every able medical statistician. But it is not easy to multi- 
ply observations to the requisite extent. Even M. Louis himself has 
been censured by M. Gavarret for having ventured to pronounce as to 
the limited efficacy of blood-letting in pneumonia, erysipelas of the face, 
and cynanche tonsillaris, on the strength of one hundred cases of the 
first disease, forty-four of the second, and twenty-three of the third ; and 
the latter gentleman lays it down as an undoubted principle, that every 
statistical inquiry, in order to furnish admissible indications, ought to 
consist of many hundreds of observations. Were this indispensable, it 
would be obviously impossible to arrive at any satisfactory knowledge 
in regard to the effect of remedies ; for, amidst the numerous shades of 
difference in the manifestations of disease, it would be difficult — if not 
impracticable — from hundreds of cases of the same malady to find a 



GENERAL CONSIDERATIONS. 41 

dozen that are circumstanced exactly alike, and that would, conse- 
quently, admit of unquestioned therapeutical deductions. 

The marked difference between the amount of information derivable 
from the system of observation inculcated by the school of Louis, when 
applied to the manifestations and to the treatment of disease, has im- 
pressed all observers. It is signally exhibited in the valuable works 
which have emanated from that school, even in those of the great mas- 
ter himself. Whilst his " Researches on Phthisis" are replete with 
accurate information on the pathological anatomy, semeiology, diagno- 
sis, termination, prognosis and etiology of the disease, — on everything 
that admits of being counted, — the treatment is meagre and unsatisfac- 
tory, consisting of little more than a catalogue of curative procedures. 
No therapeutical information is added to what was already possessed 
on the subject. These remarks apply equally to the second edition, a 
translation of which has been issued by the Sydenham Society, of Lon- 
don ; and they are perhaps even more applicable to a treatise on typhoid 
fever, which has been published in this country by one of the disciples 
of M. Louis. 

The essential difference between the applicability of the numerical 
method to diagnosis and to therapeutics is, in a great measure, the cause 
of the former being often attended to, to the exclusion of the latter ; and. 
of the separation of what has been called, by some, the science from the 
art of medicine. As a matter of scientific research it might be interest- 
ing to understand disease, even if we did not attempt to cure it ; but as 
practising physicians and philanthropists, the alleviation and cure of dis- 
ease must be the grand desiderata. Yet it has been lamentable to witness 
the almost exclusive attention, which has been paid, by many, of late 
years, to diagnosis. In hospital practice especially, the main object of 
the attending physician has too often appeared to be, — to discover, by 
physical signs and functional phenomena, the precise disease; and then 
the treatment has been left to the resident student ; — the former priding 
himself on his skill in, and attention to, the science, whilst he leaves to 
the latter what he considers to be the art. 

Hematology or observation of the blood in disease at one time 
usurped the attention of many observers — in France especially — to the 
exclusion of other important topics of inquiry. Blood was drawn in 
almost all diseases, in order to detect, by the nicest evaluation, the 
ratio of its main organic constituents to each other ; and after this had 
been determined, but little attention was, in too many cases, paid to 
treatment. The same exclusivism was observable, when, a few years 
ago, pathological anatomy was cultivated as the one thing needful : and 
when, — in France, as elsewhere, — morbid specimens were sought after, 
collected, arranged and classified, with a zeal and enthusiasm that had 
no bounds, and tolerated no opposition. 

Now, the zeal for pathological anatomy is on the wane : and it will 
not be surprising, after the numerous mutations that have occurred, if 
this valuable aid to diagnosis, and in a less degree to therapeutics, 
should experience the fate of whatever has been supported by exclusiv- 
ism ; and sink as far below its due estimation, as it previously soared 



42 GENERAL CONSIDERATIONS. 

above it. Against such a result it behooves every friend of science and 
humanity to exert himself. 

"In the early part of this century,"— says an able reviewer of 
the "Practice of Medicine" of the author, in the British and Foreign 
Medical Review, for October, 1844,— "especially after the publication of 
the works of Laennec, the current of the public mind set strongly to- 
wards pathological anatomy. Great expectations were entertained from 
it, and were, to some extent, realized in the improvement of diagnosis. 
But this result was not of a nature perfectly to satisfy the spirit— essen- 
tially utilitarian— of the profession in this country. They might for a 
time study medicine as an abstract science, but it would only be in the 
expectation of improvements in the art speedily resulting from it. But 
these results did not necessarily or speedily flow from pathological re- 
search. To recognise and name a disease was found to be one thing ; 
to cure it, another : the latter did not flow as a corollary from the for- 
mer: it occurred as a contingency infinitely more rare than was ex- 
pected ; and disappointment was the result. A change came o'er the 
spirit of the age; ' we want books useful at the bedside' was the cry; 
and, at once, as an indication of the existence of this demand, and as a 
supply to meet it, the press poured forth ' Cyclopaedias of Practical 
Medicine,' ' Libraries,' * Dictionaries,' and treatises on the same subject, 
in rapid succession, from Craigie to Watson. Our transatlantic breth- 
ren abate nothing, as is well known, of the practical and utilitarian 
character of the Anglo-Saxon race, whence they are descended, and 
were just as likely as ourselves to be soon weary of contemplating and 
classifying morbid products as some would objects of natural history, 
provided they led to no tolerably prompt result in the saving of life, or 
the alleviation of suffering. With them, too, the demand is for thera- 
peutics, and to meet this demand we have (with others) the work of Dr. 
Dunglison." 

The signal difference between the numerical investigation of disease, 
and of therapeutical agencies must — it is to be apprehended — continue. 
It may be diminished, but can never perhaps be obliterated. An accu- 
rate appreciation of facts — of numerous well observed facts — is essen- 
tial to both. A knowledge of the healthy and diseased functions or 
of physiology and pathology, and of the ordinary effects of therapeutical 
agents on those functions, obtained by careful and repeated observation, 
must be the basis of that enlightened theory, which necessarily leads to 
enlightened practice ; and great mischief would result to both, were 
we to discard all rational therapeutics, and restrict ourselves to mere 
observation. The complex functions, executed by the human organ- 
ism, are so modified by multitudinous external and internal influences 
which are inappreciable ; so much agency is perpetually exerted by the 
moral over the physique, that no comparable facts can be obtained in 
sufficient number, to admit of any accurate numerical deduction • and 
consequently, we must either treat disease in accordance with principles 
suggested by conjoined observation and reason ; experiment for our- 
selves ab initio; or resign our faith to the asserted observation and 
experience of others ; — and of these, which of the legion shall we select 
as masters ? It is fortunate, that we are possessed of such principles in 



GENERAL CONSIDERATIONS. 43 

medicine. Without them we should be unable to meet morbid mani- 
festations, which present themselves to us for the first time. "He," — 
says Dr. Abercrombie, — " who follows certain arts or practical rules, 
without a knowledge of the science on which they are founded, is the 
mere artizan or the empiric ; he cannot advance beyond the practice 
rules which are given him, or provide for new occurrences and un- 
foreseen difficulties." 

These great principles are the same every where, and by their pos- 
session we can combat disease wherever we meet with it ; amongst the 
equatorial heats, or the Siberian snows ; in the scorching presidencies 
of British India, and a fortiori in every portion of this wide-spread 
country ; on the lofty mountain and in the lowly valley ; in the pestiferous 
locality on the banks of the Mississippi, and in the more salubrious 
regions where malarious influence is unknown. It is by their posses- 
sion, that the medical officers of the army and navy are able to 
manage the diseases of all climes, when opportunity is offered them 
for adequate observation. That diseases are modified by climate or 
locality cannot be doubted, but the well instructed physician speedily 
seizes hold of the peculiarity. 

It may be inferred, then, that from every passing sect or system ; from \ 
every curative observance, rational or empirical, the judicious therapeu- 
tist may extract something that may tend to the advancement of the 
science, and the extension of his sphere of usefulness; and that it is the 
duty — as it ought to be the pleasure — of the philanthropic physician to 
adopt every improvement, no matter from what source it may emanate. 
To attempt, by the active opposition of the profession, to arrest 
even quackery of the most contemptible kind in its career, would 
be futile: — nay, more, the opposition is apt to be regarded by the 
laity as persecution, and persecution suggested by interested and 
sordid considerations. The human mind, moreover, is so constituted, 
that it loves mystery ; and reposes more faith in that which is hidden — 
if unblushingly proclaimed — than in the most open and candid exhibi- 
tion of really potent agents. All that is left, therefore, is for the pro- 
fession, in every case, to wait until the mystery has been removed, and 
then to endeavour to appreciate and embrace the good that may flow 
from it. 

Such is the view which reason and philanthropy would compel us to 
adopt ; and if there be anything perhaps that distinguishes the present 
condition of the medical mind from the past, it is the disposition of the 
wisest members of the profession to admit those principles more as 
rules of action than they did formerly. 

It behooves the student to observe well for himself, carefully, repeat- 
edly ; yet to discard not the observations of others; to reject not at 
once as apocryphal, or to hold as of no binding authority, all the 
traditions of the fathers, unless they are sustained and sanctioned by 
his own experience; but rather to respect them, and believe it possible 
that his own observation may have been defective. Under such feel- 
ings, let him subject them, on the part of himself and others, to repeated 
scrutiny ; and then, but not till then, abandon them, should they appear 
to be wanting in accuracy. Let him imbue himself profoundly with 



44 GENERAL CONSIDERATIONS. 

the great principles of physiology and pathology, simple and applied ; 
regard pathological anatomy as an aid, but an aid only, to diagnosis 
and therapeutics; endeavour to comprehend well the action of his 
remedies, and the great principles of general therapeutics ; and thus, 
fortified and guided by all the lights, which illumine the profession in 
its present advanced and advancing condition, he will be enabled to 
shine as the well informed, observing, and rational practitioner, happy 
in his own resources, and a blessing to the community whose confidence 
is reposed in him. 



THERAPEUTICAL INDICATIONS. 45 



CHAPTER II. 

CIRCUMSTANCES THAT MODIFY THERAPEUTICAL INDICATIONS. 

Age— Sex — Original conformation — Habit — Climate — Mental Affections — Races, Profes- 
sions, and way of life — Causes, seat, period, &c, of the disease. 

Having briefly alluded to the great principles that ought to guide the 
physician in laying down his indications of cure, it will be proper to 
glance at some of the chief circumstances that contribute to modify 
those indications in the treatment of disease. In all cases, general prin- 
ciples are to guide the practitioner, but as he has to treat individuals, 
circumstances may be connected with them which demand important 
modifications. 

The circumstances of a modifying nature are many. Some are con- 
nected with age, conformation, sex, professions, habit, &c; others with 
the causes, seat, intensity, period, &c, of the malady. 

1. AGE. 

This has considerable influence, especially as connected with the dif- 
ferent evolutions'which the system experiences in the progress of life, 
and which give occasion to diseases at one period of existence, that do 
not occur at others, and thus modify both the rules of Hygiene and 
Therapeutics. 

In early infancy, there is great nervous susceptibility or impressibility, 
so that mischief is liable to be produced in the encephalon by slight irri- 
tations. On this account, before and during the period of the first den- 
tition, the surgeon avoids performing any operation which he is not 
compelled to undertake. For the same reason, dentition itself is the 
cause of many phenomena of a sympathetic character, which can often 
be relieved only by attending to the condition of the gum. Irrilation 
in the intestines is also the cause of many morbid affections ; and the 
nervous impressibility, before referred to, causes them not to bear nar- 
cotics well. Again, under two years of age, large quantities of mer- 
cury may be given without the supervention of the ordinary effects of 
the medicine on the system. It is extremely difficult to salivate a child 
under two years of age; and yet at three, and afterwards, it is easy. 
This must be dependent upon some evolution, or different condition of 
the absorbent function, which is inappreciable in the present state of 
our knowledge. The mortality at this period of existence is very great, 
one-third of the whole number of deaths in our cities occurring under 
two years of age. In addition to the great tendency to disease of the 
cerebro-spinal axis, we find in summer a disposition to erethism of the 
skin and mucous membrane of the bowels ; and in winter to a similar 



46 



THERAPEUTICAL INDICATIONS 



condition of the mucous membrane of the pulmonary apparatus : accord- 
ingly, cutaneous eruptions, aphthae, diarrhoea, cholera, croup, bron- 
chitis, &c, are common at this age, owing to the susceptibility of the 
dermoid tissue to disease ; and convulsions, hydrocephalus (encephalitis) 
and other head affections, owing to the impressibility of the nervous 
system. During the whole of this period, a predominance of acidity is 
manifested in the stomach, either owing to an undue secretion of the 
acids met with in that organ in health, or to the reaction of the ele- 
ments of the food on each other, or to both ; and hence antacids are 
indicated, as well as occasional laxatives. The state of erethism in the 
mucous membrane of the intestines lays the foundation, in scrofulous 
habits, to mesenteric ganglionitis, and to consequent tabes mesenterica, 
in the same manner as a wound in the hand or foot occasions axillary 
or inguinal ganglionitis. 

Between the age of the first dentition and puberty, including the 
whole of childhood, the liability to the affections that were so fatal 
during the first two years of existence becomes amazingly diminished ; 
and the peculiarities of the earliest stage of existence gradually, and 
totally cease. 

At, and after, the age of puberty, a surprising change is observable. 
A complete revolution has been effected in the economy by the deve- 
lopment of the generative apparatus. The morbid tendency is now to 
the lungs ; and consumption — that dread disease, which, in these climes, 
is estimated to destroy at least one-sixth of the population — is rife. 

During the whole period of virility no particular modification is pro- 
duced by the evolution of organs. All goes on with greater uniformity, 
so that no new morbid tendency seems to be developed. It is. the 
standard period for all our physiological and therapeutical descriptions, 
unless otherwise specified. If we speak of the dose of a medicine 
abstractedly, we mean the quantity usually needed by an adult male to 
procure the ordinary effects of the drug. 

Lastly : — in old age, the nervous susceptibility becomes, in general, 
diminished, so that larger doses — of particular kinds of remedies at 
least — are needed, and a greater supply of food is demanded, in order 
that the enfeebled powers of chylosis may be able to extract from it the 
adequate supply of chyle. The torpor of the intestinal functions is at 
times so great, that the excrement collects in quantities in the lower 
part of the bowels, and occasionally it becomes so much indurated, that 
mechanical means, — as enemata, or the use of a scoop, — are needed 
for its removal. The tendency, too, to disease of the urinary organs, 
and especially of the prostate and bladder, is considerable at this time 
of life, and but few individuals attain the age of eighty without bein^ 
more or less incommoded in this manner. 

Connected with the pathology of old age, M. Begin has laid down the 
too general law, — that in ths greater part of old people, disease is the 
result of chronic irritations, produced in the organs by the long con- 
tinued repetition of the stimulations that accompany the normal exercise 
of the functions. This is improbable. It cannot readily be con- 
ceived how any continuance of healthy stimulations should bring on 
disease in these or other parts. In the exhausted condition of the nerv- 



MODIFIED BY SEX. 47 

ous agency, obstruction or irregularity of action is apt to be induced ; 
and such obstruction, or morbid depositions, dependent upon irregu- 
larity of action, may thus become the source of irritation, and organic 
disease. All the morbid affections, indeed, of old age, are irritative as 
at other ages. Chronic gastritis, ascites, enlarged liver, visceral en- 
gorgements, chronic bronchitis in all its forms, asthma, angina pectoris, 
chronic affections of the heart in general, are diseases of irritation, ori- 
ginating in some irregularity, or in debility of the organs implicated, but 
not in their simple continued healthy action. 

At all ages, then, the treatment of disease must be, in its general 
principles, the same ; but it requires to be varied according to the 
strength of the individual, and the evolution of the organs at different 
periods of existence. 

2. SEX. 

Prior to the period of puberty, there are but few points of difference 
between the sexes, as far as relates to therapeutics. From organi- 
zation, there is a greater mobility and impressibility in the nervous sys- 
tem of the female, but this is not manifested before she becomes nubile, 
or before the genital apparatus has experienced the evolution that befals 
it at puberty. After this, all the functions are apt to be modified by the 
new condition of the uterine organs. A periodical discharge is estab- 
lished, and if this be in any manner interfered with, the organic irrita- 
tion, which ought to have existed in the ovaries and uterus, is trans- 
ferred to other parts, and the one most predisposed to take on morbid 
action assumes it. Hence it is, that attention has always to be paid to 
the state of this function, when the therapeutist is called upon to examine 
diseases of other parts, that may be obscurely connected with the uterine 
functions, through the extensive sympathy which they maintain. This 
is signally shown when the catamenia do not appear at the usual age ; 
or when, after having occurred regularly, they become obstructed. 
Whilst they, too, are flowing, the female is generally extremely im- 
pressible, so that active remedies — especially such as affect the lower 
part of the bowels, or the urinary organs, and excite the uterus through 
contiguous sympathy — have to be used with caution. 

The period at which the catamenia cease is also one of interest to the 
therapeutist. The female is then so proverbially liable to irregularity 
in the functions, and in the nutrition of organs, that it has been called, 
even by the unprofessional — "the critical period.'' Prior to 1 their total 
disappearance, the catamenia may recur irregularly ; and chronic irrita- 
tions be thus developed in the sexual organs, or elsewhere. The mammae, 
having lost the sympathetic influence exerted between them and the 
uterus, are apt to assume a morbid condition, and to become the seat 
of irritations of a specific kind — as of cancer — which appeared to be 
previously held in check by the play of the healthy sympathies. Yet, 
although the female is more liable to disease at this time, it would not 
seem from the results of statistical inquiry that the absolute mortality is 
increased. 

It is obvious, then, that the state of the uterine function must be an 



48 THERAPEUTICAL INDICATIONS 

important object of inquiry in many of the diseases to which the sex is 
liable ; that when the catamenia are present, the flow must not be offi- 
ciously interfered with ; and if modified, either owing to the proper 
periodical irritation having been arrested, or to the flow occurring in too 
great quantity, appropriate measures for altering these conditions must 
be had recourse to. ... 

At one time, it was universally presumed, that hysteria is occasioned 
altogether by the state of the uterus, and hence its name, from vvtm, 
"the uterus," and the German name — Mutt erkrankh eit or 
" womb disease." It occurs, however, in man ; is essentially a dis- 
ease of the nervous system, and probably prevails more in females only 
because they possess greater mobility, and irritability of the nervous 
system, — doubtless often developed by the particular condition of the 
uterus reacting on the nervous system, but appearing — as in the male — 
where no such influence can exist. 

The presence of the uterine system constitutes, therefore, the main 
difference in the indications to be laid down for the treatment of female 
diseases, as well as in the mode of fulfilling those indications ; and in 
all cases the therapeutist has to inquire carefully, whether that system 
be primarily or secondarily affected. In many cases of functional aber- 
ration of the uterus, he will find, that the cause is seated in the state of 
the general system, or in some other part of the organism ; and the case 
may be much complicated by the reflection of the uterine irritation to 
other organs. 

After all, however, the treatment of the majority of the diseases that 
attack females as well as males must be based upon the same great 
general principles ; — the chief modifying circumstance to be borne in 
mind being, that the female is more susceptible of impressions than the 
male, and consequently, as a general rule, does not require the same 
dose of any remedial agent, although the same agents may be demanded. 
In managing diseases that are of a sexual character, this great modi- 
fying circumstance has to be recollected. 

In the anomalies that occur at the commencement, or cessation of 
menstruation, the pathologist must be guided by his acquaintance with 
the laws of physiology and pathology, and establish his indications ac- 
cordingly. 

The state of utero-gestation is a point, connected with the female, 
which demands consideration. The various sympathetic disorders, that 
may arise, have to be palliated by the most gentle agents. The original 
cause being seated in the gravid uterus cannot, of course, be removed, 
and palliation alone remains. No violent medicinal agents can be pre- 
scribed without hazard. Powerful excitants are especially objectionable; 
and hence the hot bath cannot be used with impunity. Anything that 
interferes with the due nutrition of the foetus in utero, or that can give 
occasion to uterine contraction, is obviously improper. It is necessary, 
also, to bear in mind, that the blood of the pregnant female usually 
presents the buffy coat, or that appearance, which has been so generally 
regarded as the universal product of inflammation as to be called the 
" inflammatory crust ;" and it is still maintained by some, that this crust 
on the blood of pregnant women only appears when inflammatory irrita- 



MODIFIED BY ORIGINAL CONFORMATION. 49 

tion exists. Certain, however, it is, that we witness it where there are 
no other signs of inflammation. When the crust occurs in inflammation, 
the ratio of the fibrin to the red corpuscles appears to be increased ; and 
there is a greater aggregation between the particles of the fibrin and 
between the corpuscles themselves ; the fibrin is longer in coagulating, 
and time is thus allowed for the subsidence of the corpuscles to the bot- 
tom of the vessel. The fibrin, devoid of red corpuscles, then forms the 
upper crust or stratum, which is the buff. In like manner, it might be 
understood, that under the new draughts, which are indirectly made 
from the maternal blood during pregnancy, its condition may be modi- 
fied so as to give rise to the phenomenon in question. As a general rule, 
the pathologist regards the appearance of the crust on the blood as a 
strong proof of the presence of inflammation ; and, when he would 
otherwise have remained in doubt, is encouraged, by this sign, to re- 
peat blood-letting. In pregnancy, such an inference from the appearance 
of the blood drawn might, for the reasons stated above, be erroneous; 
yet in many parts of this country, it is not unusual for a female to be 
bled five or six times during the period of pregnancy : — often three or 
or four times ; and if blood should not have been drawn, and any un- 
fortunate event should occur, it is apt to be ascribed to a neglect of this 
fancied prophylactic. It is strange that a process, which every one would 
readily admit to be natural in the animal, and to require no remedial 
means, should be regarded as pathological in women. The notion has, 
however, been encouraged by some of the medical profession of no little 
celebrity, especially by Sauvages, who places pregnancy in the order 
Intumescentice of his Nosology ; and by Linnaeus, who ranges it under 
Tumidosi (morbi). 

During the period of nursing, the practitioner has to attend to another 
circumstance ; viz., that the action of his medicinal agents may not be 
confined to the female : the infant at the breast may be affected like- 
wise. Absorption is active, in consequence of the constant secretion 
from the mammae, and certain substances may, therefore, be taken up 
in sufficient quantity to affect the child injuriously. 

I. ORIGINAL CONFORMATION. 

There are many circumstances, connected with original conformation, 
which exert a modifying influence, both hygienically and therapeuti- 
cally. Singular as it may seem, it is indubitable, that from the moment 
of a fecundating copulation, the new being is impressed with an impulse, 
which gives occasion to such a formation as may predispose the off- 
spring, at some period of its existence, to a disease that affected the male 
or the female parent. In this way, a conformation may result, which 
may favour the development of consumption, apoplexy, or scrofula, at 
certain ages, under the action of adequate exciting causes. Hence it is, 
that we find so much difference in the constitutions of different persons. 
The constitution of an individual is the organization proper to him ; and 
he is said to have a strong, or a delicate, a good, or a bad constitution, 
who is appareatly strong or feeble, — usually in good health, or liable to 
repeated attacks of disease. The varieties of constitution are, therefore, 

Vol. I.— 4 



50 



THERAPEUTICAL INDICATIONS 



as numerous as individuals. A strong constitution is considered to be 
dependent upon a due development of the principal organs of the body, 
on a happy proportion between those organs, and on a fit state of energy 
of the nervous system ; whilst a feeble or weak constitution results from 
a want of these postulates : but it is obvious, that our knowledge on 
this matter must be somewhat limited, although, by a careful examina- 
tion, we may be able to appreciate or rather to approximate it. 

It is daily observed in our intercourse with man, in a state of health, 
or disease, that certain persons possess much more irritability or impres- 
sibility than others. This irritability or impressibility is connected 
with the nervous system, and through it every tissue of the body may be 
affected, by virtue of the contractility or excitability which it possesses. 
Men certainly possess very different degrees of nervous energy, and 
of susceptibility to impressions ; and, consequently, great diversity in 
the degree to which they are predisposed to disease, and in the action 
of remedies. Persons of very great nervous susceptibility are sensibly 
alive to atmospheric vicissitudes ; have the Ccencesthesis, or u common 
feeling" — G e m e i n ge f u h 1 of the Germans — extremely acute ; are lan- 
guid, listless, and depressed in a lowering atmosphere ; buoyant, and 
elastic, or "corky" — to use the language of the '« trainers" — when the 
air is dry and serene. We see the same variety in the w r ay in which 
powerful emotions, or impressions on the senses, affect different indivi- 
duals. Some persons faint from the slightest shock made on any of the 
senses ; others are thrown into convulsions by causes, which, in others 
again, would excite no perceptible emotion. The over-excitement of a 
nervous individual concerns us materially in the employment and effects 
of our therapeutical agents. With such individuals, the slightest cause 
may produce fever, owing to the irritation of the nervous system extend- 
ing to the vascular, and causing in it augmented action. Usually, the 
febrile irritation, thus induced, is only ephemeral ; but if there be any 
part of the capillary system, ow r ing to obstruction, or morbid derange- 
ment, strongly predisposed to assume the inflammatory condition, such 
a condition may be induced by the force with which the blood is pro- 
pelled by the heart and arteries. The circulatory system is not directly 
influenced by the brain or spinal marrow, but it is so indirectly. We 
see this in the effect of emotions. The heart leaps with joy ; and under 
the influence of certain passions its actions are hurried and unequal. 
Nay, the effect extends even to the small vessels, — to those through which 
secretion is effected in the glandular system. At the sight of a cherished 
article of food, the salivary glands secrete so rapidly as to cause the 
" mouth to water," and the saliva to be projected to a distance from it. 
It is an important principle, not to be lost sight of in Therapeutics, 
that the condition of the circulatory is largely influenced by that of the 
nervous system ; and it is especially important to bear this in mind in 
the management of febrile and inflammatory diseases. If blood-letting 
be pushed to a very great extent in such cases, it induces irregularity 
of action, and irritability of the nervous system, and in this way local 
determinations and hyperaemiae may be, and often are, caused by the 
very means employed to obviate them. This effect of copious loss of 
blood is instructively exemplified in uterine hemorrhage. A female 



MODIFIED BY ORIGINAL CONFORMATION. 51 

after delivery, may be reduced to death's door by the profuse discharge 
of blood. She may be almost pulseless, pale, and exanguious ; and yet, 
in the course of a few hours after she has rallied, the most violent deter- 
mination may take place to the head — as indicated by intolerable cepha- 
lalgia, and violent throbbing of the carotid, and temporal arteries, — a 
state induced by the irregularity above described as apt to be engen- 
dered by that irritability of the nervous system, which follows a profuse 
discharge of blood. In such a case, farther blood-letting obviously 
cannot be indicated. The irritability of the nervous system must first 
be allayed ; and accordingly, the author has found the most decided 
advantage from the use of opium, administered in such a dose, and in 
such a form, as to ensure the speedy production of its full sedative in- 
fluence. When this begins to be exerted, the activity of the encephalic 
circulation gradually yields ; and in a short time the whole mischief 
disappears. If blood-letting be had recourse to, — even to a moderate 
extent, and it could not be carried far in this reduced state of the 
system, — it is calculated to augment the pathological condition which 
it was intended to remove. The advantage attending a union of copi- 
ous bleeding with sedative doses of opium can thus be readily appreciated. 
The abstraction of blood reduces the amount of stimulus in the sangui- 
ferous system, whilst the opium keeps down the excitement of the ner- 
vous system. 

In particular diseases, the nerves are remarkably susceptible to im- 
pressions. In neuralgia faciei, the slightest motion of the muscles — 
the least breath of air — induces excruciating torment ; and in hydro- 
phobia, the distress and horror are chiefly occasioned by the impression 
of certain objects on the organ of sight. Some persons, again, suffer 
much more from pain than others. This is the case with different ani- 
mals. The idea, that the beetle, when trod upon, feels as much as the 
giant when he dies, is poetical, but probably untrue. Some persons are 
thrown into the greatest nervous distress— the most intolerable anguish 
— by the application of a blister ; and it is well known, that all do not 
bear surgical operations equally well. This is doubtless greatly depen- 
dent upon organization, although it may be modified by habits of endu- 
rance, or the contrary. The state of the mind exerts a powerful influence 
in this respect. The religious fanatic, and the martyr to political 
excitement, have exhibited a resistance to physical agents almost in- 
credible. 

The condition of the nervous system can never be wholly disregarded 
by the therapeutist. Whenever it is morbidly impressed, the operation 
of medicines is interfered with ; and regular physiological actions may 
be modified. We see this last effect exhibited in the parturient female. 
Labour may have been proceeding in the most favourable manner, but 
if anything should interfere with the attendance of the practitioner who 
has been expected, and another should present himself; and still more, 
if the latter should have an unprepossessing appearance, the pains may 
subside, and delivery be greatly retarded ; whilst if the accoucheur, 
in whom the female had reposed her confidence, had presented himself, 
the termination might have been much facilitated. Dr. A. T. Thomson 
gives the following aneddote as illustrative of the control of the mind 



52 THERAPEUTICAL INDICATIONS 

over the operation of medicines, where the whole effect must obviously 
have been induced through the nervous agency modifying the functions 
of the organs concerned. A lady was labouring under an affection of 
the bowels, attended with severe pain and the most obstinate costive- 
ness. She was bled ; the warm bath, and fomentations were frequently 
resorted to ; and purgatives and various anodynes were freely adminis- 
tered, but without the least effect upon the bowels, and without either 
sleep, or any diminution of pain ensuing. At length, the physician in 
attendance was informed that she had expressed her conviction, that 
her usual medical attendant, who was in the country, alone understood 
her constitution, and was the only person who could relieve her. This 
gentleman was accordingly sent for ; and although no change, either of 
measures, or of medicine, was resorted to, the bowels were quickly 
moved ; sleep, and cessation of pain followed, and in a few days the 
patient was convalescent. He further remarks, that he has witnessed 
frequent illustrations of this influence of mind in modifying the effects of 
medicines, in the treatment of gonorrhoea contracted by married men; 
or by young men, possessed of a high feeling of moral rectitude. The 
anxiety of such persons to be speedily cured occasions the mind to be 
constantly directed to the seat of the disease ; and more or less erethism 
is thus induced there, which renders the cure difficult. Dr. Thomson 
thinks, that " a vascular fulness of the mucous membrane, and a state 
resembling chronic inflammation' , are thus superinduced, which resists 
the influence of medicines, that would readily cure the disease in those 
in whom it was a matter of less anxiety, and little mental reflection. It 
is obviously, therefore, of moment, in all affections, particularly in those 
of an inflammatory character, that the mind should not be permitted to 
brood over the malady ; and that every endeavour should be made to 
withdraw the nervous influence from the part affected, as far as this can 
be done with propriety. It is in this way, that revulsive applications 
exert a portion of their beneficial agency. They not only excite the 
parts to which they are applied, so as to break in upon the morbid cate- 
nation elsewhere existing, but they attract the attention ; and the nervous 
influx which would otherwise be directed towards the suffering organ is 
diverted towards the part artificially irritated. 

Much stress has been placed on the influence of temperament in a 
pathological as well as therapeutical point of view. The subject of the 
temperaments, asually admitted, belongs to physiology. The sanguine ; 
the bilious or choleric ; the melancholic or atrabilious ; the phlegma- 
tic, lymphatic or pituitous, and the nervous are generally received and 
described by writers ; but if we attend to their reputed characteristics 
the imperfection of their definition and demarcation is obvious; so im- 
perfect, indeed, are they, that it is very rare for us to meet with an 
individual, whom we could unhesitatingly refer to any one of them 
They are likewise susceptible of important modifications from climate 
education, &c, and may be so combined as to constitute innumerable' 




MODIFIED BY TEMPERAMENT. 53 

activity, and impetuosity, ascribed to the bilious temperament, may, by 
slothful indulgence, be converted into the lymphatic or phlegmatic. All 
these temperaments acquired their names from a fancied predominance 
of certain humours, which so tempered the different functions as to com- 
municate corresponding characteristics. In a therapeutical considera- 
tion, they do not demand much attention, except perhaps so far as 
regards the two opposite — the sanguine, and the melancholic; and 
perhaps the nervous. The first of these is presumed to be dependent 
upon a predominance of the circulatory system ; and hence is considered 
to be characterized by strong, frequent, and regular pulse ; ruddy com- 
plexion ; animated countenance ; good shape, although distinctly 
marked ; firm flesh ; light hair ; fair skin ; blue eyes ; nervous suscep- 
tibility, attended with rapid successibilite, as the French term it, — that 
is, a facility of being impressed by external objects, and of passing 
rapidly from one idea to another. On the other hand, in the melancholic 
temperament, the vital functions are considered to be more feebly or 
irregularly performed ; the skin has a deeper hue ; the countenance is 
sallow, or sad; the bowels are torpid, and all the excretions tardily 
accomplished ; the pulse is hard, and habitually contracted. In the 
nervous temperament, again, the susceptibility of being acted upon by 
external impressions is unusually developed. It is characterized by 
small, soft, and, as it were, wasted muscles ; and generally by a slender 
form, and great vividness of sensation. 

Such are the characters ordinarily assigned to the temperaments. 
Many of them are fallacious, and but few need be borne in mind in the- 
rapeutical investigations. As a general rule, it certainly would seem, 
that persons of strong sanguine characteristics have the nervous system 
more impressible ; the body more predisposed to inflammatory action, 
and the vessels less protected by the tissues in which they creep ; 
hence they are more liable to obstructions, as well as to hemorrhage by 
rupture or transudation ; and it is manifest, that in such an organization 
antiphlogistics may be more demanded, and stimulants ought to be em- 
ployed with more caution, than in that of the melancholic. Again, the 
possessor of the nervous temperament may demand modifications of 
management, both hygienical and therapeutical, which may not be sug- 
gested in those of any of the other temperaments. 

After all, however, we cannot deduce much instructive matter, for 
our practical guidance, from the study of this subject ; nor does it seem 
to the author, that the doctrine of the temperaments in any of its rela- 
tions—physiological or psychological — hygienical or therapeutical — is 
worthy of the consideration that has been bestowed upon it. In The- 
rapeutics, the nature of the diseased action going on in an organ is the 
great object of study ; and if our thoughts are distracted from this, and 
directed to temperaments or tendencies, we may often be greatly misled. 
Many years ago, the author was requested to visit a lady for the first 
time, in the absence of the regular physician, who had long attended 
her, and had become what is called ** acquainted with her constitution." 
She was labouring under profuse metrorrhagia, which had continued 
for some time, and had completely prostrated her ; she was deadly pale ; 



54 THERAPEUTICAL INDICATIONS 

lips blanched ; pulse scarcely perceptible ; and every evidence present, 
that the hemorrhage was not continuing from activity of vessels ; or, at 
all events, that the idea of activity must be laid aside in the treatment, 
and the powers of life be supported,— otherwise she would sink. The 
uterus was in an unimpregnated state. The usual means with the tam- 
pon were adopted successfully, so far as regarded the immediate flow ; 
and a tonic system of medication was recommended, under which the 
hemorrhage did not' recur during the day. In the evening, the family 
physician arrived, who finding her in a comfortable situation, and evi- 
dently improving, discontinued the tonics, under the apprehension, 
from his knowledge of her sanguine temperament, that violent reaction 
and consequent mischief might ensue; but in the night he was called 
up, owing to the alarming recurrence of the hemorrhage, and was glad 
to have recourse to the management, which had previously proved suc- 
cessful ; under which she ultimately recovered, and since that period — 
twenty-five years ago — has had no return of the disease. In this case, 
a " knowledge of the constitution" was likely to have been attended 
with disastrous results. The diseased condition is, indeed, the point to 
which attention has to be directed ; and it is the only one that can, in 
general, fall under the personal observation of the physician, in the mode, 
at all events, in which the profession is regulated in England. The 
apothecary is there the family practitioner, and the physician is only 
called in consultation ; so that the chief part of the practice of the latter 
must necessarily occur in persons, with whose constitution he has had 
no opportunity of being previously acquainted. 

Temperament is conformation, but Idiosyncrasy — or the peculiar dis- 
position which causes an individual to be affected by extraneous bodies, 
in a way in which mankind in general are not acted upon by the same 
agents — may be acquired ; and when once it has been so, it is apt to con- 
tinue, and frequently does so, throughout the whole of existence. The 
author possesses a singular idiosyncrasy. If a piece of thin biscuit, 
or oaten-cake, be broken in his presence, — nay, the idea of the ac- 
tion is sufficient, — the muscles, that raise the left angle of the mouth, 
contract irresistibly. It is obviously of moment, that the practitioner 
should be acquainted with all idiosyncrasies or peculiarities, and so far 
the notion of " knowing the constitution" — which is apt to be used to 
the prejudice of the young practitioner, or of any except the accustomed 
medical attendant — carries reason with it. But it is the duty of the 
patient to put the practitioner in possession of the fact of such peculiar- 
ity, so that he may be enabled to guard against it, and not take that for 
morbid, which is the effect of simple idiosyncrasy. 

By virtue of these peculiarities, medicines often produce effects dia- 
metrically opposite to those which they ordinarily exert. The author 
knows a gentleman whom opium purges ; yet this drug is usually admi- 
nistered to check inordinate action of the intestinal tube. Mr. Chevalier 
gives the case of a lady, who could not take powdered rhubarb without 
an erysipelatous efflorescence showing itself, almost immediately after- 
wards, on the skin ; yet, what is singular, she could take it in the form 
of infusion with perfect impunity. It is impossible for the physician to 



MODIFIED BY IDIOSYNCRASY. 55 

detect these peculiarities by any signs. His information has to be 
wholly derived from the patient. But when* once acquired, he is ex- 
pected to retain it; and, strange as it may seem, all confidence in him 
is at times annihilated, because he may not have recollected that oil 
of peppermint, or some other trivial agent, was in the habit of disagree- 
ing with his patient. It is apt to be regarded as an evidence that he did 
not attend sufficiently to the constitution; and the inference is drawn, 
that without this, his endeavours could not have secured the full amount 
of success, whilst his inattention might have been productive of injurious 
effects, owing to the irritation that might have been induced, by the 
development of this adventitious sympathy, in a frame already disturbed 
by morbid influences. 

There are very few functions of the body that are altogether free from 
idiosyncrasies. An acquaintance of the author cannot be present where 
ipecacuanha is being powdered, without the most violent catarrhal and 
asthmatic symptoms being produced; and many similar cases are 
recorded. The smell of the callicanthus is so disagreeable to another 
as to be almost intolerable. Pope Pius VI. had such an antipathy to 
musk, that on an occasion of presentation, an individual of the company 
having been scented with it, his holiness was obliged to dismiss the 
party almost instantaneously. These are idiosyncrasies or peculiarities 
connected with smells, which are agreeable to the generality of man- 
kind. 

• On the other hand, by some, offensive smells are preferred. The 
author knew a lady, who always perfumed her snuff with assafcetida ; 
and Louis XIV. is said to have preferred the smell of the urine of the 
cat to that of the rose. Some persons, again, cannot take peppermint, 
and with many opium disagrees, producing the most intolerable head- 
ache, nausea, and vomiting, and exciting no anodyne effect whatever. 
Dr. Thomson refers to the case of an individual, who was always at- 
tacked with syncope when he took the smallest dose of calomel. But 
peculiarities of this kind are innumerable ; and the practitioner ought to 
be put in possession of them by his patient, otherwise disagreeable 
results may take place ; the economy be needlessly disordered, or 
effects, opposite to those which the article usually induces, follow. 
Several such peculiarities are referred to in the author's Human Physi- 
ology. 

The different impressibility of the nervous system in different indivi- 
duals is often exemplified, in practice, in the effect produced upon the 
circulation by the appearance of the physician. The pulse of a delicate 
female, under such circumstances, is often quickened 20 or 30 beats in 
the minute ; a fact which the physician must bear in mind, or he may 
ascribe to disease what is the mere effect of idiosyncrasy. In some 
persons, the pulse is unusually slow. The ordinary number of beats of 
Napoleon's was 44 in the minute ; the author knew one 36 ; and Liz- 
zari refers to one, which did not number more than 10 : but it is possible, 
that in this case there might have been intermediate beats unperceived 
by the observer. On the other hand, some individuals have the pulse 
much quicker than ordinary. „ Seventy beats in the minute is about the 
average in the healthy male ; but sometimes the number in health is as 



56 THERAPEUTICAL INDICATIONS 

high as 90 or 100. The pulse of the aged is generally more frequent 
than that of the adult, and is irregular, or intermittent; but it is occa- 
sionally unusually frequent and regular. A change of this kind occurred 
to a valued friend of the author, who had filled the highest office in the 
gift of his countrymen. Until about the age of 80, his pulse possessed 
the usual character appertaining to that of the aged ; but, for some years 
before his death, it became quicker, — beating nearly 90 in the minute, 
and more regularly than it had done. During early childhood, the 
same intermittent and irregular character exists in health; but the pulse 
is faster than in the adult. As a general rule, at birth, the number of 
pulsations may be from 130 to 140 ; at one year, 120 ; at two years, 
110 ; at three years and up to ten, 90 and upwards; at puberty, 80; 
at the adult age, 70 ; and in old age, something higher. In the female, 
the pulse is on the average from five to ten beats quicker than in the 
male. 

All these circumstances have, of course, to be borne in mind in in- 
vestigating any case of disease. But owing to such individual pecu- 
liarities it becomes, at times, extremely difficult to pronounce upon the 
existence of a morbid condition from the pulse^ — more especially as 
regards its degree of quickness or slowness, — inasmuch as we are rarely 
acquainted with the number of beats in the state of health. It is partly 
on this account, that Celsus termed it " res fallacissima ;" yet, it has 
even been made the ground of discrimination in a case of suspected 
insanity, and by an illustrious native of this country, whose eminent 
abilities were at times obscured by his unbounded enthusiasm, and too 
prolific imagination. In counterfeited insanity — Dr. Rush remarks — the 
pulse will be natural ; in real insanity — and it has been since established 
by observers — it is generally more excited than in a state of health ; and 
this Dr. Cooper has introduced into his collection of" Tracts on Medi- 
cal Jurisprudence," as a fixed and invariable law; — to which, at least, 
he has not attached any doubt or exception. " The knowledge of this 
fact," adds Dr. Rush, "has once been applied with success in the ad- 
ministration of the criminal laws of the United States. One of the two 
men who were condemned to die for treason, committed against the 
general government in the western counties of Pennsylvania in the year 
1794, was said to have lost his reason after sentence of death had been 
pronounced upon him. A physician was consulted upon his case, who 
declared his madness to be feigned. General Washington, then Presi- 
dent of the United States, directed a consultation of physicians upon his 
case. Dr. Shippen, Dr. Samuel P. Griffits, and myself were appointed 
for that purpose. The man spoke coherently upon several subjects ; 
and for a while the state of his mind appeared doubtful. I suggested 
the propriety of examining his pulse : it was more frequent by twenty 
strokes in a minute, than in the healthy state of the body and mind. 
Dr. Shippen ascribed this to fear. I then requested that the pulse of 
his companion in guilt and fear might be felt. It was perfectly natural 
in frequency and force. This discovery induced us to unite in a certifi- 
cate, that the man, who was only supposed to be mad, was really so : 
in consequence of which his execution, as well as that of his conpanion' 
were suspended for two months ; in which time the popular clamor for 
their.lives so far subsided, that they were both pardoned by the execu- 



MODIFIED BY HABIT. 57 

tive of the United States." This is perhaps the ne plus ultra of medical 
philanthropy, certainly not of medical science ! 

From all that has been said, it is manifest, that idiosyncrasy must 
have much power in modifying the operation of medicines. It is, con- 
sequently, important for the practitioner to be aware of this ; and it may 
not be amiss for him to make specific inquiries when he wishes to ad- 
minister such drugs as are apt to disagree with certain individuals, — of 
which opium and its preparations, and calomel, are perhaps the most 
prominent. 

4. HABIT. 

By this is understood an acquired disposition in the living body, be- 
come permanent, and as imperious as any of those primitive acts, which 
have been also, in another sense, denominated habits. When a function 
is over and over again exerted to the utmost extent of which it is capa- 
ble, both as regards energy, and activity, or is exerted beyond the ordi- 
nary extent, it becomes more and more easy of execution ; the organ is 
better adapted for its production ; and, it may become so habituated to 
this over-exertion, that a real want may be engendered, a " second 
nature," and the individual may feel uncomfortable, unless the organ 
is subjected to the accustomed action. In the same way, by habit, the 
action of an organ may be diminished, until ultimately it is but little 
adapted for the exercise of its full power. The knowledge of these 
facts has led one of the most gifted and ingenious naturalists of the pre- 
sent age — M. De Lamarck — to affirm, that the habits of an animal are 
not dependent upon its organization ; but that, on the contrary, its 
habits, mode of life, and those of its ancestors have, in the succession 
of ages, determined the form of its body, the number and condition of 
its organs, and the functions and the faculties it enjoys, — a position, 
which he has supported with much plausibility, and, at the same time, 
with much that approximates to the reductio ad absurdum ; — for exam- 
ple, when he takes the case of reptiles, which, as well as other verte- 
brated animals, in his view, had originally, according to the great plan 
of organization, four paws attached to the trunk. Serpents must con- 
sequently have had four ; but having assumed the habit of creeping 
along the ground, and of concealing themselves in the grass, their 
bodies, owing to perpetual efforts at elongation, to enable them to pass 
into narrow spaces, acquired an unusual length in no wise proportionate 
to their thickness. Paws would have been quite useless. Long paws 
would have interfered with their creeping, and very short paws would 
have been but ill adapted for moving the body. Hence, the want of 
employment of these parts being constant, they gradually disappeared ; 
although, says M. De Lamarck, they may have originally entered into 
the plan of organization of animals of their class. 

But, although this distinguished naturalist carries the influence of 
function on organization to an extent, that cannot be maintained ; it 
is certain, that the habitual exercise of an organ does add to its develop- 
ment within certain limits ; whilst inaction gives occasion to its im- 
poverishment. We have this signally exemplified, if we restrict an 



5S THERAPEUTICAL INDICATIONS 

animal to diet of a different character from that to which it had been 
accustomed, — or to one foreign to its nature. In birds of prey, the 
digastric muscle — which is strong in the gallinaceous bird — has the 
bellies composing it so weak, that, according to Sir Everard Home, 
nothing but an accurate examination can determine its existence. But 
if a bird of this kind, be compelled from want of animal food to live 
upon grain, the bellies of the muscle become so large, that they would 
not be recognised as belonging to the stomach of a bird of prey. Mr. 
Hunter kept a seagull for a year upon grain ; after which he found the 
strength of the muscle greatly augmented. This wondrous adaptation 
of structure to the kind of food, which the animal is capable of obtain- 
ing, is likewise shown in the South American, and the African ostrich. 
The former is the native of a more productive soil than the latter ; and 
accordingly the gastric glands are less complex, and numerous, and the 
triturating organ is less developed. 

It is owing to the effect of long-protracted action upon the body, that 
old and inveterate habits cannot be suddenly broken in upon with im- 
punity. Issues, and long-continued discharges of all kinds must be 
gradually checked prior to total occlusion ; otherwise, the irritation, and 
consequent afflux, may be directed to other and important organs, which 
may be, at the time, specially disposed to assume a morbid action. 

In like manner, where a person has been in the habit of daily indulg- 
ing in the unmeasured use of spirituous liquors, he cannot safely with- 
draw, at once, the accustomed excitant. The nervous system, habituated ( 
to stimulation, totters, if it be abandoned ; and delirium tremens, 
with all its horrors, almost surely supervenes. In times of spread- 
ing sickness, such sudden and total change of inveterate habits adds, 
no doubt, greatly to the extent of the calamity. The drunkard becomes 
alarmed ; abandons his stimulant ; and, under the depression that fol- 
lows, readily receives the morbific influence, and sinks a victim to in- 
cautious reformation. 

The effect of medicines on the frame is much influenced by habit. 
As a generar rule, continued use diminishes it. This is signally 
shown in the case- of opium. Instances are related, in which two 
drachms, or one hundred and twenty grains, of solid opium, or five 
fluidounces of laudanum, have been taken in twenty-four hours ; yet 
before the habit was induced these persons could not have taken five 
grains of opium without danger. 

But although this habit of endurance or resistance may have been 
acquired in the case of opium, it does not follow that the organism, thus 
rendered obdurate to it, will resist large doses of other narcotics. It may, 
indeed, be affected with considerable facility, provided another narcotic 
be substituted. In like manner, if a person has been habituated to the use 
of aloes as a cathartic, it may altogether lose its effect; yet if we 

change the special irritant, or have recourse to another cathartic castor 

oil, or sulphate of magnesia, for example — catharsis may be produced 
by an ordinary dose. It does not, therefore, follow, that the sensibility 
of the mucous membrane of the intestinal canal becomes blunted in 
these cases. It merely loses its impressibility as regards one irritant* 



MODIFIED BY CLIMMTE. 59 

whilst it may be equally susceptible of irritation from any other of 
the class. 

According to this general effect of habit, it would follow, that the 
second dose of a cathartic ought to be larger than the first, provided it 
be administered within such a period, that the influence of the first dose 
continues to be felt; and it is the usual practice with the physician to 
direct the after dose to be larger: but there are some cathartics, which 
appear to differ in their action upon the mucous surface so as to render 
it more impressible, — many of the salines, for example. This effect 
has long been ascribed to Cheltenham water. It would seem, too, 
that the constitution, so far from becoming reconciled to lead by habit, 
is rendered more and more sensible to its irritation. Emetics, also, fre- 
quently act more powerfully by repetition. Dr. Cullen affirms, that he 
knew a person so accustomed to excite vomiting on himself, that the 
one-twentieth part of a grain of the tartrate of antimony and potassa 
was sufficient to produce a convulsive action of the parts concerned in 
vomiting. This difference as to the effects of agents by repetition we 
observe in disease. In certain cases, after the system has been once 
morbidly impressed, it is ever afterwards unsusceptible of the same 
mischief; in others, it is less susceptible; whilst, in others again, it is 
rendered unusually impressible. The last effect is seen in the case of 
miasmata — those at least that give rise to intermittent fever. A per- 
son, who has once suffered under a pernicious, severe, or even ordinary 
intermittent, may need a less dose of the malaria to reproduce the dis- 
ease than was required to occasion the first attack ; and, in some, the 
nervous system becomes so impressible, that a chill is experienced 
whenever they enter upon a soil that is exhaling the miasm. Persons 
so extraordinarily impressible have, indeed, been employed to indicate 
the existence or non-existence of malarious exhalations in given locali- 
ties. In the seventy-second number of the " Edinburgh Review," a 
writer pronounced several districts surrounding St. James' Park, in 
London to be malarious, on the faith of an " animated miasmometer"— 
an officer who had suffered from the malarious " Walcheren fever!" 

It may be laid down then, as a general rule, that remedies lose their 
effect by habit ; and this is often strikingly the case with tonics ; but 
if another tonic be substituted for a day or two, and the former be after- 
wards resumed, it may produce all its previous effects. Although, 
however, this is the general rule, it admits of numerous exceptions. 

5. CLIMATE. 

The capability of existing in all regions is one of the attributes of 
humanity. Man is, however, considerably modified in his physical and 
mental characteristics by climate and locality. The temperate zone 
appears to be best adapted for his full development; and it is there, 
that the greatest ornaments of mankind have existed, and that science 
and art have flourished in plenitude. In torrid regions, the sensibility 
is over-excited ; physical and moral energy is lost, and the native of the 
temperate zone, who has entered them full of life and buoyancy, has 
quitted them, after a few years' residence, listless, 'and shorn of his 



60 THERAPEUTICAL INDICATIONS 

proudest characteristics. The frigid zone, on the other hand, is equally 
unfavourable to mental, and corporeal development, — the sensibility 
being blunted by the rigor of the climate. The effect of locality is 
signally exemplified in the cretin and goitreux of the Valais, and of 
situations at the base of lofty mountains in almost every part of the 
globe ; as well as in the inhabitants of our low countries, who are con- 
stantly exposed to malarious exhalations, and bear the sallow imprint on 
their countenances. All the circumstances connected with the causation 
of endemic disease exhibit the powerful morbid influence of climate and 
locality ; and the outward conformation of the natives of different coun- 
tries is an equal exemplification of their physiological influence. It is 
owing to such climatic modification, that we are enabled to distinguish 
the Frenchman from the Spaniard, Italian and Portuguese, although 
belonging originally to the same great Romanic stem ; as well as to 
discriminate the different branches of the Teutonic race — the German, 
Dutch, and the Scandinavian — from each other. 

As regards the disposition to disease of special organs induced by 
climate, it may be laid down as a general truth, that hot climates dis- 
pose to bilious complications. Heat occasions erethism of the whole 
dermoid system ; — hence diarrhoea, dysentery, cholera morbus, &c, 
dependent upon irritation or inflammation of the lining membrane of the 
intestines ; and such irritation, may be propagated by continuous sym- 
pathy along the biliary ducts to the liver, and in this way disease of that 
viscus may become induced by the influence of heat. The mode 
adopted at Strasburg and Metz, for enlarging the liver of the goose, 
is elucidative of this subject. (See the author's Human Health, 
p. 27, Philad. 1844.) 

On the other hand, in cold climates, there is a greater tendency to 
inflammation of the mucous membrane of the air passages; — the irregu- 
larity in the cutaneous and pulmonary transpirations gives occasion to 
local excitement in the bronchial mucous membrane, which is not 
always restricted to that expansion, but in favouring habits may extend 
to the substance of the lungs, so as to develope pulmonary consump- 
tion. Hence, the effects of change of climate — especially the removal 
from a temperate to a torrid region, or conversely — become an interest- 
ing topic of inquiry to the physician in a hygienical as well as therapeu- 
tical point of view. The author has elsewhere shown, that owing to the 
great nervous susceptibility induced by the heat of the warmer climes, 
such climes are unfit for those that are predisposed to mania, and to 
head affections in general; whilst they are, cceteris paribus, the best 
that could be selected for such as are predisposed to pulmonary con- 
sumption, although most fatal to the same class of patients when the 
consumption has become confirmed. 

The circumstances, that modify the physiological and pathological 
condition of man, necessarily modify also the mode of fulfilling thera- 
peutical indications which may be obvious. The well-instructed phy- 
sician readily detects those differences, otherwise it would be neces- 
sary that every student should be educated in the country where he 
has to practise his profession. The practitioners, who are destined to 
exercise their calling in British India, receive their education in the 



MODIFIED BY CLIMATE. 61 

mother country ; and Philadelphia sends her alumni to practise in 
Maine, in Louisiana, and indeed in every part of the globe to which 
the interest of the nation, or the thirst of gain leads the hardy and ven- 
turous citizen. The principles of the science — as before remarked — 
are alike every where ; and but slight observation is requisite to guide 
the properly instructed mind to the appreciation of climatic differences 
of every kind. 

Climate has some influence, but not much, in modifying the action 
of remedies. Dr. Harrison found, that narcotics produced more effect 
in Naples than in England. He instances the extract of hyoscyamus, 
w T hich, in doses of three grains, three times a day, at Naples, produced 
temporary amaurosis or nervous blindness, which disappeared and recurred 
on the alternate suspension and administration of the medicine. This 
was observed in two patients, who had often taken similar doses of the 
same remedy in England without any unpleasant result, — an effect 
which Dr. Harrison refers to the increased nervous susceptibility or 
impressibility induced by the warmer climate. It might be suggested, 
that a source of fallacy existed in the circumstance of the Italian extract 
being more powerful than the English ; but, in answer to this, Dr. Har- 
rison remarks, that the medicine, which he administered in Italy, was 
procured from London. The same gentleman found, moreover, as a 
general rule, that the doses of medicines ordered in England were too 
large for the climate of Italy. The rule, indeed, may be extended, 
and it may be laid down, that remedies act more powerfully, or pro- 
duce the same effect in smaller doses in hot climates, owing to the 
greater nervous susceptibility of the residents of such climates. Still, 
to this there are numerous exceptions. In referring to the subject, Dr. 
Thomson remarks, that "it does not always follow, that the doses of 
medicine require to be reduced in warm climates ; on the contrary, in 
India, a scruple of calomel and a grain of opium are frequently adminis- 
tered, and repeated at short intervals, after depletion, in dysentery ;" and 
he adds, — what must amuse the residents of many of the malarious dis- 
tricts of this country, and especially of the valley of the Mississippi — 
that u but few physicians would venture to prescribe this active remedy, 
in such large doses in this climate," — in other words, in temperate 
climates. fThe truth is, that the action of calomel is but imperfectly H^- 
understood.^ The French speak with horror of the doses administered 
by the English ; and in some parts of this country they are equally sur- 
prised at the small doses in which it is employed in England. The 
author well recollects the tone in which a distinguished French army 
physician spoke of the hardihood of the English physicians in prescrib- 
ing three grain doses of calomel; yet there are practitioners in this 
country, who give it in the dose of one hundred, or one hundred and 
fifty grains, and even more. These immense doses do not produce a 
purgative effect in a direct ratio with the dose. On the contrary, two 
or three grains may be actively cathartic, whilst twenty may not pro- 
duce more, or as much, effect. After bleeding especially, absorption is 
active; the calomel speedily attains the circulation, and is given off' by 
cutaneous exhalations, as is evidenced by the effect produced upon a 
gold watch worn by the patient. Such appears to be the effect of a 



62 < THERAPEUTICAL INDICATIONS 

very large dose, even when blood-letting has not been premised, whilst 
a small dose appears to irritate — without there being the stimulus of 
quantity to induce its absorption — and has a cathartic agency. In this 
way, a large dose of calomel may defeat the object of the prescriber 
who wishes to produce catharsis; and, by undergoing absorption and 
coming in contact, through the blood, with the tissues, it may excite a 
new action in the whole nutritive and secretory system ; and even if we 
admit, that when given in unusual quantity it is altogether harmless, 
the superfluous amount must be esteemed a waste of the article. 

In all the cases in which such large doses of calomel are administered, 
the practitioner is led to persuade himself, that the climate requires 
them. But this argument is often fallacious, and may be employed to 
bolster up any plan, that has received without sufficient examination 
the approbation of a part or of most of the profession. Not many years 
ago, in the fevers of the South and West, calomel was considered to 
be indispensable, the " Sampson article of the materia medica," as it was 
often floridly termed. Now, it is affirmed by many to be always unne- 
cessary, and often injurious, whilst the sulphate of quinia is looked 
upon as the remedy par excellence. It has been a common opinion, 
too, that in our ordinary bilious fevers, copious blood-letting, and the 
most active and irritating cathartics are imperiously demanded ; and the 
practice founded upon this belief was at one time universal, — so much 
so, that no other was adopted extensively until of late years; but since 
a greater degree of attention has been paid to the condition of the 
mucous membranes in these affections, and a better philosophy has 
suggested, that whilst we are keeping the different external sensitive 
surfaces free from all irritation, we ought not to be perpetually irritating 
the intestinal dermoid prolongation, practitioners have been induced to 
abandon the constant use of irritating cathartics ; to keep the digestive 
canal free by the use of mild cathartics, which remove the morbid 
secretions as they are formed ; and, by the proper use of sedatives — of 
which blood-letting is almost the only one — and of refrigerants, to 
reduce the inflammatory excitement. By such a plan — and experience 
can be equally adduced in its support — the ordinary bilious fevers of 
our country will be found to yield more satisfactorily than under the 
mixed sedative and irritating treatment, which was formerly universal; 
and still prevails too extensively. It is obvious that where one sys- 
tem of medication is exclusively employed, it is impossible to draw 
any deductions from comparison ; and we are not justified in affirming, 
that climate requires one system more than another until an equal trial 
has been made of all. 

The therapeutist has opportunities for witnessing the modifying influ- 
ence of climate, when individuals pass from a torrid to a temperate or 
a frigid zone, and conversely. If the removal has been from a hot to a 
cold climate, the impressibility is diminished, and larger doses of medi- 
cines are necessary to produce the wonted effect ; if from a cold to a 
hot, the impressibility is augmented ; smaller doses are necessary ; and, 
owing to the same cause, less powerful excitants produce fever and 
stimulating drinks have to be carefully avoided. " With respe'ct to 
inuring foreigners to a country," says a modern writer on Therapeutics— 



MODIFIED BY SEASONS. 63 

M. Begin — " we are to preserve their organs against the impression of 
the climate, whose influence has been studiously examined. Thus, the 
inhabitants of the south, when transplanted into cold and damp climates, 
should keep their bodies warmly clothed, to preserve themselves from 
bronchitis and pneumonia, to which they become much exposed ; and 
they are to assume gradually the use of warm and somewhat stimulating 
drinks. A substantial diet, consisting of animal food, with the mode- 
rate use of spirituous liquors, are the precepts to be observed in passing 
from a warm to a colder climate. Complete sobriety, and the use of 
vegetable food, are, on the contrary, necessary for those who pass from 
a northern to a southern latitude. In marshy places, abounding in sim- 
ple or pernicious intermittents ; — in those climates that are devastated 
by plague, yellow fever, cholera morbus, or dysentery, it is necessary 
to shun the action of the deleterious miasmata, to approach only by de- 
grees the foyers of infection, to avoid intemperance of all kinds, and 
every excess, which, by increasing their susceptibility and irritating the 
digestive organs, evidently dispose to endemic diseases." 

These last recommendations are equally applicable where the change 
of residence has been from a warmer to a colder region, even where 
there may be no endemic disease. It has been a matter of repeated 
observation, that the habit acquired during a sojourn of some duration 
in any climate remains for some time after a removal to one of an opposite 
character. Dr. Edwards has shown this as regards the physiological 
performance of certain functions, and it has been long noticed patholo- 
gically in the watering and other sanitaria of Great Britain, — the resorts 
of the healthy and the valetudinarian from British India. Whatever 
complaint may attack the stranger, it is apt to assume the intermit- 
tent type, which has been impressed on the organism by previ- 
ous residence in a hot and markedly malarious region. In such 
cases, too, the predisposition to disease of those textures, in which 
erethism is produced by great atmospheric heat, is manifest. It is to 
individuals thus circumstanced, that M. Begin recommends the tolerably 
free use of spirituous liquors — a measure, to say the least of it, doubt- 
ful ; and, in the author's opinion, more likely to produce irregularity of 
action, than any regimen that could be advised, — as it is impossible to 
keep up the excitation uniformly ; depression must therefore succeed to 
the stimulation, and the former in a degree proportionate to the extent 
of the latter. In such a condition, morbific agents must necessarily 
impress the economy more powerfully than if all had been regularity in 
place of disorder. 

What has been said of climate, as respects temperature, applies also 
to seasons. During the summer, the tendency of diseased excitement 
is to the mucous membrane of the alimentary canal ; during the winter, 
to that of the lungs. The summer season is extremely fatal to infants 
in our cities, owing to a disease — cholera infantum — which consists 
essentially in erethism of the lining membrane of the tube, and is 
apparently produced by the combined action of heat and deteriorated 
air. The former alone appears to be insufficient to account for its pre- 
valence, as it is rare in country situations, where an equal elevation of 



64 THERAPEUTICAL INDICATIONS 

temperature may prevail ; and one of the most certain modes of preven- 
tion is to remove the infant from the town to the country. 

6. MENTAL AFFECTIONS. 

There are numerous opportunities for observing the powerful effects 
induced by the affective faculties on the different functions when in a 
state of health. All these are caused by sympathetic association with 
the brain ; the organ secondarily affected being in a state of excitation 
or depression according to the precise character of the emotion. Of the 
therapeutical influence of the emotions, the author will have to treat 
hereafter, — some of them being important agents in the removal of dif- 
ferent forms of disease. The effects of one of the intellectual faculties, 
when inordinately exerted, on the bodily functions, are signal; and to 
these must be ascribed cures, that are said to have been effected by 
modes of management — often of the most revolting character — from time 
to time in vogue. In nervous, delicate, and imaginative persons, pains 
can be felt any where : sometimes, too, disease is developed in this 
manner ; and, at others, feelings are experienced as distressing as if 
they resulted from actual disease. 

It is through the imagination and its influence on the body, that we 
must explain the effects of credulity and superstition, so long employed 
as therapeutical agencies. At one period in the history of medical sci- 
ence, the materia medica consisted almost wholly of the machinery of 
magic. Some, indeed, as Pliny, affirm, that magic was wholly derived 
from medicine ; but without inquiring into their precise order of pre- 
cedence it is certain, that there was a close affinity between them. 
The word Ananazipta, scrawled on parchment, was said to cool fever. 
Abracadabra, supposed by Selden to be the name of a Syrian idol, 
figured on an amulet, and worn round the neck, was supposed to pos- 
sess the power of curing ague, and of preventing many diseases, espe- 
cially when uttered in a certain form, and a certain number of times. 
An hexameter from the " Iliad" allayed the agony of gout, aud rheu- 
matism yielded to a verse of the " Lamentations." In all these cases, 
the effects upon the physical ailment may have been produced through 
the action of the mind on the body, of which we have so many marked 
examples, and to some of which reference will be made presently; but, 
in other cases, the incantation w T as used where such agency could 
scarcely be presumed. Cato, the Censor, for example, pretended to be 
able to reduce luxations, after the manner of the Etruscans and Pytha- 
goreans, by barbarous expressions, and by magical songs ; such as 

" motas vaeta daries dardaries astatutaries," or " huat haut huat ista 
pista sista, domiabo damnaustra et luxato." Homer, too, affirms that the 
bleeding of the wounded Ulysses was stopped by a charm, and the no- 
tion has passed down to the present enlightened age, and prevails in 
certain parts of Great Britain. It is referred to by Sir Walter Scott in 
the " Lay of the Last Minstrel," and is noticed frequently in the popular 
poetry of the last century but one. In all these cases, however it is 
probable that the enchanter employed more direct appliances to the in- 
jured part, as in the " cure by sympathy," to which reference has already 



MODIFIED BY MENTAL AFFECTIONS. 65 

been made, and that he had. not therefore implicit confidence in his 
charms. The only remnant of the notion of charms, yet retained in 
medical language, is the word "carminative," applied to a class of me- 
dicinal substances, employed in cases, which were usually cured, or 
attempted to be cured, by carmina or incantations in verse, or to such 
as operated like carmina or verse charms. 

It need scarcely be said, that whatever curative influence was exerted 
by the ceremonies in the temples of old must have been through the 
moral on the physique ; by the new impressions made on the nervous 
system, and on the imagination through the senses, thus indirectly mo- 
difying the whole system of nutrition. Even in those distant periods, 
however, we have seen, that judicious advice, in regard' to diet and 
regimen, was given, which could not fail to produce salutary results. 
Such, too, was the case with the sympathetic powders employed in the 
treatment of wounds ; and it was equally so with the Royal Touch, so 
extensively employed at one time for the cure of scrofula or King's 
evil, by the sovereigns of England and France, whose peculiar attri- 
bute it has been claimed to be ; but history does not sanction this — as* 
might, indeed, be expected — for it appears to have been not unfre- 
quently employed in Scandinavia, and to have been derived from the 
mystical practices of the Druids in curing disease. In France, the prac- 
tice was continued, on the occasions of solemn ceremonials, up to the 
reign of Louis the Fifteenth ; and it is stated, by an historian of the 
period, that on Easter Sunday, in the year 1686, sixteen hundred per- 
sons were touched by Louis the Fourteenth, — the words used by the 
King being — "Le Roy te touche, Dieu te guerisse" — u The King touches 
thee: may God cure thee." In the reign of Louis the Fourteenth, it 
fell into disuse; but was revived as recently as the time of Charles X., 
deposed in 1830, who touched at his coronation. In England, the 
origin of the touch is ascribed to Edward the Confessor, who ascended 
the throne in 1041. But the belief in its efficacy appears to have been 
greatest in the reign of Charles the Second. After the Restoration, the 
numbers that flocked to Whitehall and Windsor almost exceed belief. 
An exact register was kept of those who were admitted ; and in twelve 
years, — it appears — ninety-two thousand one hundred and seven persons 
were touched ; and in one day — in June, 1660, — si$ hundred! With 
the reign of Charles, however, the faith and confidence in the efficacy 
of the Royal Touch subsided. It is recorded, however, that, at the 
suggestion of Sir John Floyer, a distinguished physician of the day, then 
residing at Lichfield, the mother of Dr. Samuel Johnson carried him to 
London to be touched by Quee'n Anne, but without effect. On the 
same day, March 30th, 1714, two hundred persons were touched ; and 
this would seem to have been the last occasion on which the touch was 
publicly practised in England ; as, upon the accession of the House of 
Brunswick, the degrading mummery was discontinued. 

And can we doubt for a moment, that the main agency, in these 
cases, was through the nervous system, in the manner already mentioned. 
After the Restoration of Charles II., the whole kingdom was in a state 
of high mental excitement ; and for a time never was monarch more 
over-estimated. All this would, of necessity, render his touch more 

Vol. I.— 5 



66 THERAPEUTICAL INDICATIONS 

effective ; and, accordingly, a larger proportion was considered to have 
been cured by him than by any other monarch. The idea, too, was 
maintained, that the gift could only be advantageously exercised by one 
who was a king by Divine right; and we can, therefore, comprehend, 
during the existence of such a belief, that Cromwell may have failed, 
and that his royal successor might have been more fortunate. We are 
told, .indeed, that Cromwell tried in vain to exercise this royal preroga- 
tive ; " he"— says a loyal writer of the day—" having no more right to 
the healing power than he had to the royal jurisdiction ;" and the key 
to the solution of the mystery is suggested by the remark, that after the 
Restoration none ever failed of receiving benefit, " unless their little 
faith and incredulity starved their merits." 

That there was positive efficacy in this Royal Touch in scrofula there 
can be no doubt. Old Wiseman — one of the fathers of surgery in Eng- 
land, and whose name is inseparably associated with its history — de- 
clares, in his Treatise on Scrofula, " that his Majesty" — meaning 
Charles the Second, — " cureth more in anyone year than all the chirur- 
I geons of London have done in an age ;" and he affirms, — " I myself 
have been a frequent eye-witness of many hundreds of cures performed 
by his Majesty's touch alone, without any assistance of chirurgery, and 
those, many of them, such as had tired out the endeavours of able 
chirurgeons before they came thither." Yet no one at the present day 
I would believe, for a moment, that any special virtue existed in the touch 
of royalty ; for precisely the same results followed the touch and the 
invocations of Valentine Greatrakes in the 17th century, of whom the 
Royal Society of London expressed the incomprehensible opinion, that 
his success depended upon a "sanative contagion in his body." 

It would be as impossible, as unadvisable, to instance the various 
shapes, which superstition, applied to medicine, has assumed ; and the 
hold which it has taken on the minds of many, whose station in society, 
and whose general attainments, it might have been presumed, would 
have steeled them against the intrusion of such beliefs. The science of 
medicine has suffered largely from the credulity and ignorance of those 
who profess it ; and nothing can exhibit this more strikingly than the 
repulsive, and ridiculous agents, which have been had recourse to as a 
part of the materia medica ; some of which were introduced or recom- 
mended by individuals, distinguished in their day for superior intelli- 
gence. Thus, Bacon believed in the virtue of charms, and amulets; 
and Boyle thought the thigh bone of an executed criminal a powerful 
remedy in dysentery. Celsus advised the warm blood of a recently 
slain gladiator, or a certain portion of human or horse flesh, for the cure 
of epilepsy; and remedies of this description are said to have been 
actually exhibited, with success, for the cure of epileptics, in the poor- 
house at Haerlem, by Abraham Kaauw Boerhaave, nephew to the cele- 
brated Hermann, and professor of medicine at St. Petersburg-, who 
lived so recently as the middle of the last century. Amongst the spe- 
cifics of Alexander of Tralles were — the liver of a weasel freed from 
bile, taken for three successive days, fasting; the skull of an ass, and 
the ashes of clothes stained with the blood of gladiators. Pliny recom- 
mends stones, taken from the craws of young swallows, in epilepsy. 



MODIFIED BY MENTAL AFFECTIONS. 67 

Democritus mentions, that some diseases are best cured by anointing 
with the blood of strangers and malefactors, and others with the blood 
of our friends and kinsfolk. Miletus cured affections of the eyes with 
human bile. Artemon treated epilepsy with dead men's skulls ; and 
Antheus, convulsions with human brains. 

It may be said, that most of these degrading examples of credulous 
ignorance are taken from a far distant age, when physical science was 
yet in its infancy. It would be easy, however, to show, that, at a much 
later period, the same credulity reigned where it was least to be expected ; 
and even now, the pharmacopoeias of certain countries, eminent amongst 
nations for the advanced condition of mind in many of its aspects, exhibit 
evidences of the like degradation. Sir Theodore Turquetde Mayerne — 
who was physician to James the First, Charles the First, and Charles 
the Second, of England, and who was the most distinguished character 
of his day for learning, and as a practitioner— mentions, among his 
remedies, the balsam of bats for hypochondriasis ; remedies taken from 
certain parts of adders ; sucking whelps ; earth-worms; mummy made 
of the lungs of a man who died a violent death ; and many other articles 
equally gross, and irrational. Even a century after this period of 
defective observation and experience, no great advancement had taken 
place towards a knowledge of the effects of medicines on the animal 
economy. The doctrines of pathology were experiencing considerable 
mutation ; anatomy and physiology were beginning to be vigorously 
cultivated ; many improvements had taken place in the practice of 
medicine and surgery, and an immense number of new articles had 
been added to the materia raedica, of which comparatively few, how- 
ever, have been since retained ; yet no great improvement had occurred 
in the discrimination of false from true facts, so far, at least, as regards 
the medicinal virtues of those articles which act insensibly on the frame, 
and which have been commonly denominated " alteratives." 

The lists of the materia medica of this country and of Great Britain 
are free from those offsprings of superstition and credulity, although 
they may be objectionable for the multitude of articles admitted into 
them. Time, however, and improved observation and reflection will 
rectify this evil, until — fortunately for the student, practitioner, and 
patient, — the list will embrace those agents only, whose virtues and . 
applications are understood. Valuable time is frequently lost in the 
exhibition of a remedy of doubtful efficacy. " Anceps remedium quam 
nullum" is, indeed, a maxim of by no means universal application. 
The safety of the patient is often endangered by the credulity of the 
physician. In this way, the use of amulets, anodyne necklaces, cam- 
phor worn round the neck, &c, is objectionable. Presuming on their 
prophylactic or remedial powers, the wearer is apt to pass rashly into 
infected situations, when he would otherwise have been cautious, and, 
if attacked with disease, postpones the employment of efficacious reme- 

jntil the time has gone by for their successful administration. 
^ a x)ifferent bezoards or calculi found in the stomachs of animals, and 
at one time generally presumed to. have the power of warding off con- 
tagious diseases, were to be found in the pharmacopoeias of Amsterdam, 
Brunswick, Spain, and Wirtemberg. A distilled water of young swal- 



68 THERAPEUTICAL INDICATIONS 

lows — officinally called Aqua hirundinum cum castoreo — existed in the 
pharmacopoeia of Manheim, as an anti-hysteric and anti-epileptic ;— 
the oniscus or woodlouse was in most of the European pharmacopoeias, 
as a remedy in dropsy, and asthma ; — the powder of the dried frog, 
Bufo exsiccatus, in the Pharmacopoeias of Spain and Wirtemberg, as an 
anti-hydropic ; the powder of the human skull in the same pharmacopoeias, 
as an anti-epileptic ; the dried liver of the mad dog, and that of the wolf, in 
the pharmacopoeia of Wirtemberg, as an anti-hydrophobic ; the Egyp- 
tian mummy in those of Spain and Wirtemberg, with the hoof of the 
stag, formerly regarded as a specific in epilepsy ; besides many other 
articles equally absurd. Their retention is unfavourable to the scientific 
observation and induction of the people into whose pharmacopoeias they 
are received ; and it is somewhat surprising, that amidst the various 
pharmacopoeias of German origin, that of Wirtemberg should be so far 
behind in rejecting the relics of ancient ignorance. A useful lesson 
may, however, be deduced from all these facts. Many of the articles 
are calculated to produce considerable effect upon the imagination, and 
thus, they may really have been productive of advantage in the treat- 
ment of disease. Who, for example, could be told, that he was about 
to take a pill made of the powder of the human skull, or of an Egyptian 
mummy, without considerable emotion ? Accordingly, it will be found, 
that most of these disgusting agents, as well as of the various nauseous 
remedies, yet retained in the pharmacopoeias, — assafcetid a, castor, skunk- 
cabbage, &c, — are administered to the nervous, and the hysterical, as 
well as in the various affections that occur in paroxysms, to make a 
powerful impression on the nervous system, and thus break in upon the 
nervous erethism existing elsewhere. In this way, we account for the 
action of many anti-spasmodics, anti-epileptics, anti-hysterics, febrifuges 
administered for arresting intermittents, &c. ; and for the efficacy of 
those methods of acting on the imagination, — animal magnetism, Per- 
kinism, &c, — that have excited the most extravagant enthusiasm, and 
then died away, leaving scarcely a vestige of their having been ; but 
may be resuscitated. under some other form, unless the experience of the 
past — by which, however, mankind are slow to profit — and the rapid 
diffusion of intellectual and mor,al light should be sufficient to choke 
them at their resurrection. 

f Perkinism, one of the most arrant delusions in the whole history of 
credulity, is the product of our own soil. Its proposer — Elisha Perkins 
of Connecticut — is represented to have been a man of strict honour and 
integrity; but manifestly of an ardent imagination, and unbounded cre- 
dulity. Impressed with the idea, that metallic substances might exert 
some agency on the muscles, and nerves of animals, and be inservient 
to useful purposes, as external agents, in the treatment of disease he 
professed to institute various experiments, until he ultimately fancied he 
had discovered a composition, which would serve his purpose and of 
which he formed his " metallic tractors." These consisted of two in- 
struments, — one having the appearance of steel, the other of brass. They 
were about three inches long; and pointed at one extremity ; and the 
mode of their application was to draw the points over the affected parts 
in a downward direction for about twenty minutes each time. The effects 



MODIFIED BY MENTAL AFFECTIONS. 69 

seemed to be miraculous. The whole class of diseases on which the 
imagination is known to exert its efficacy, — and it will be seen after- 
wards, that it is most extensive, — rheumatism, local pains of various 
kinds, and in various parts, paroxysms of intermittents, &c, yielded as 
if by magic. The operation was termed Perkinism by the faculty of 
Copenhagen, in honour of the inventor ; and institutions were formed 
in Great Britain, which were regarded for a time — that is, during the 
existence of the delusion — as sources for the dispensation of health to 
suffering thousands. 

The following is from the report of the " Perkinistic Committee" of 
London on the establishment of their institution ! " Mr. Perkins," (the 
son of the proposer) u has annually laid before the public a large collec- 
tion of new cases, communicated to him for that purpose, by disinter- 
ested and intelligent characters from almost every quarter of Great 
Britain. In regard to the competency of these vouchers, it will be 
sufficient simply to state, that, amongst others, whose names have been 
attached to their communications, are eight professors in four different 
universities ; twenty-one regular physicians, nineteen surgeons, thirty 
clergymen, twelve of whom are Doctors of Divinity, and numerous 
other characters of equal respectability. The cases published by these 
gentlemen in March last, the date of Mr. Perkins' last publication, 
amount to about Jive thousand. Supposing that not more than one cure 
in three hundred, which the tractors have performed, has been published 
—and the proportion is probably much greater — it will be seen that the 
number to March last will have exceeded one million Jive hundred 
thousand." 

With such apparently overwhelming testimony in its favour, can we 
be greatly surprised, that sufficient enthusiasm should have been excited 
amongst the credulous for the establishment of the Perkinistic Institu- 
tion ? A meeting was called for the purpose ; the undertaking was 
unanimously resolved upon, and a subscription opened to carry the pro- 
posed charity into effect. The list was soon honoured by above a hun- 
dred subscribers, several with a donation of ten guineas, and only one 
or two subscribing annually less than one guinea. Lord Rivers was 
elected President of the Society ; and eleven other persons of distinction, 
among whom was Governor Franklin, son of the illustrious Doctor, 
Composed the list of vice-presidents. On the 25th of July, 1803, a large 
house was opened in Frith street, Soho square, for the reception of 
patients, and in which the medical attendant, matron, and servants 
constantly resided. The objects of this establishment- — as stated by the 
society in their publication on the subject — appeared to be philanthropic, 
and were as follows: — First. To afford relief to the disorders of the 
afflicted and industrious poor of the metropolis, if the remedy should be 
found capable of that desirable purpose : and — Secondly. To submit 
the long controverted question on the merits of the metallic tractors to 
the test of the severest scrutiny, the ordeal of experiment by disinterested 
persons, and thereby enable the public to form a correct opinion on 
the just pretensions of Perkinism ;" — and it was farther proposed, in 
the report of the committee, that the British Parliament should investi- 
gate the merits of Perkinism, " and if convinced of its utility, honour it 



70 THERAPEUTICAL INDICATIONS 

with similar patronage to other modern discoveries for the benefit of 
mankind." Yet, humiliating reflection ! In a very brief space of time, 
the enthusiasm and the institution died away ; and no one, at the present 
day, believes that the effect of Perkinism was anything more than an 
additional illustration of the success that must ever follow, for a time, 
the efforts of empiricism and pretension. Whilst the delusion was at its 
height, Dr. Haygarth determined to ascertain how far the effects might 
be ascribed to the imagination. He accordingly formed pieces of wood 
into the shape of tractors, and with much assumed pomp and ceremony 
applied them to a number of sick persons, who had been previously pre- 
pared to expect something extraordinary. He not only employed them 
in nervous diseases, but in all kinds of cases ; and the effects were found 
to be astonishing. Obstinate pains of the limbs were suddenly cured. 
Joints, that had been long immovable, were restored to motion, and, 
u in short," says Dr. Bostock, " except the renewal of lost parts, or the 
change of mechanical structure, nothing seemed beyond their power to 
accomplish." 

Animal magnetism, as well as the employment of the magnet for the 
cure of disease, is, at the present day, exerting its therapeutical influ- 
ence, partly through the same agencies. It is in such cases as those in 
which the tractors were found beneficial, that they succeed. 

The seventh son of a seventh son is presumed to possess miraculous 
healing powers ; and Mr. Phillips, in his excellent Treatise on Scrofula, 
states, that there is still, or was lately, in Devonshire, a farmer who is a 
ninth son of a ninth son, and supposed, in consequence of his birth- 
right, to be endowed with extraordinary powers of healing : he strikes 
for the evil, one day every week ; " and an intelligent surgeon informs 
me," — says Mr. Phillips — " that some of his cures in scrofulous cases, 
1 are really astonishing.' His fame is high in his district, and he takes 
care to preserve his credit by not undertaking the cure of all cases." 

All these facts lead us back to the great influence exerted by the 
moral on the physique. Daily experience shows how satisfactorily a 
case of disease may proceed, if the faith of the patient be implicitly 
yielded to the physician, and to the mode of treatment he is pursuing ; 
and how unhappily everything is apt to go on, when the contrary is the 
fact. The author has already cited a case, in which the same remedy 
had opposite effects, when prescribed by two different physicians — the 
confidence of the patient being reposed in the one, and not in the other. 
It is equally important, for the successful operation of a medicine, that 
the confidence of the patient should be reposed in it, otherwise disap- 
pointment is apt to ensue ; and, on the other hand, imagination or faith 
may render inert medicines efficacious, and may even — as before re- 
marked — cause a medicine to have effects very different from those 
which it usually exerts. 

A female patient was admitted into the County Asylum at Hanwell, 
under Sir William Ellis. She imagined she was labouring under a 
complaint which required the use of mercury ; but Sir William discov- 
ering that the idea of the existence of that disease was an insane delu- 
sion, yet considering that flattering the opinion of the lunatic to a certain 
degree might be favourable to her recovery, prescribed bread pills for 



MODIFIED BY MENTAL AFFECTIONS. 71 

her, and called them mercurial pills ; after a few days, she was sali- 
vated, and the pills were discontinued. On again prescribing them after 
the salivation had subsided, she was a second time affected in the same 
manner • and this happened again on a third recurrence to the use of 
the pills. 

The late Dr. James Gregory, of Edinburgh, was in the habit of relat- 
ing an anecdote in his lectures, in illustration of the same subject. A 
student, who was labouring under fever, and was under the care of the 
doctor, required the administration of an anodyne ; he was accordingly 
informed by the doctor, that he would order one for him, to be taken at 
bed-time. The patient, however, thought he said cathartic. The next 
morning, w r hen Dr. Gregory called, he inquired what effect the anodyne 
had produced? *' Anodyne /" replied the young man, "I understood 
it was a purgative, and a very active one it has proved. 1 have had 
four copious stools, and feel much relieved. " 

In Dr. Paris's life of Sir Humphry Davy, there is a case equally in- 
structive. Dr. Beddoes having inferred, that the inhalation of the nitrous 
oxide must be a specific for palsy, a patient was selected for trial, and 
placed under the care of young Davy. Previous to administering the 
gas, Davy inserted a small thermometer under the tongue of the patient 
to ascertain the temperature. The paralytic, deeply impressed by Dr. 
Beddoes with the certainty of the success of the remedy, of which he 
knew nothing, no sooner had the thermometer in his mouth than he de- 
clared he felt better. Nothing more was done, and the sick man was 
requested to return on the following day. The same ceremony was 
repeated with the same result, and, at the end of a fortnight, he was 
dismissed cured, — no remedy of any kind, except the thermometer, 
having been used ! 

In an interesting account of the influence exerted on the public health 
of Hamburg, by the great fire there in 1842, Dr. Zimmerman states, that 
many bedridden invalids arose, and displayed supernatural force and 
energy ; and that some of them remained permanently cured. Diar- 
rhoea, mania, and apoplexy were the principal diseases observed. 

It will be easily understood, then, how important and extensive may 
the influence be exerted by the mind over the body in a therapeutical 
point of view, and that it is not unimportant to inquire into the likes and 
dislikes, the prepossessions and antipathies, of patients. It often hap- 
pens, that in the course of a long disease a desire is felt for particular 
articles of diet, which may not seem, at first sight, extremely appro- 
priate ; but, in such cases, unless manifest evil would be likely to re- 
sult, it is better to humour the individual, or at least not to resist him 
strongly ; for it occasionally happens, that instinctive desires or appetites 
are experienced, which may not only be indulged in moderation with 
impunity, but with obvious benefit. The refrigerant regimen was at 
one time carefully avoided ; — so long indeed as the doctrine of concoc- 
tion of humours persisted ; and one of the greatest improvements in the 
practice of physic, as applied to febrile diseases, is the free adoption of 
the cooling system, whenever the state of the body will admit of it. 
Instinct here led the way, and experience has proved the correctness of 
its monitions. " The efforts of the practitioner, in a case of simple fever, 



72 THERAPEUTICAL INDICATIONS 

are, indeed, mainly restricted to the employment of the refrigerant class 
of remedies. A prejudice is still found, however, against the use of iced 
water in fever>here calomel is given. The feeling existed strongly in 
many parts of the Southern and Middle states ; but it is rapidly yielding, 
and ought to be altogether abandoned. Cases may have occurred in 
which individuals have caught cold, or have had disagreeable symptoms 
supervening, when cold water has been taken after calomel; but they have 
been cases of the post hoc, rather than of the propter hoc. The author 
has been, for years, in the habit of allowing the use of iced water after 
calomel in fevers, and has never had the slightest evidence of any disa- 
greeable results from it. 

7. RACES, PROFESSIONS, AND WAY OF LIFE. 

These exert much influence not only on the susceptibility to disease, 
but on the indications of cure, and the mode in which these indications 
have to be fulfilled. This is exemplified in the agency of alcoholic 
potations, when used to excess for any length of time. By passing 
into the mass of blood, and penetrating every tissue, they modify\the 
action of the system of nutrition everywhere ; and the whole frame be- 
comes liable to unhealthy inflammatory excitement, on the application 
of causes, which would have been incapable of producing such results 
before the system had been thus inordinately excited. The draymen, 
porters, coal-heavers and others of the British metropolis, who drink a 
gallon or more of strong porter during the day, and daily, although they 
may present the appearance of rude health, are liable to erysipelatous in- 
flammation after the slightest external injury; and, when attacked by 
severe internal disease, do not bear the abstraction of blood like those of 
sound constitution and temperate habits. 

But, independently of such habits, mode of life has a manifest effect 
upon the organism. The labourer, who is exposed to every vicissitude, 
is less susceptible of impressions, and consequently demands larger 
doses of medicines to produce the same effect, than he who is brought 
up in idleness and luxury. The effect of such habits is to render the 
frame extremely impressible, and hence the number of the nervous and 
the hysterical is infinitely greater amongst the upper classes of society. 
In this country, the difference of way of life cannot be exhibited to the 
same extent as in Oriental climes, where a distinct classification exists 
in society. Amidst the revolutions that occur in the fate of families, 
where the law of primogeniture does not hold, there is not much oppor- 
tunity for tracing the effects of labour or of luxury through many gene- 
rations; but in Hindostan, where a difference of castes has existed from 
time immemorial, and where the barriers are effectually closed against 
the entrance of the unprivileged, the effect is clearly shown. The arti- 
sans are above the tillers of the soil ; and they exhibit in their confor- 
mation, as well as in their functions, the influence of a greater decree 
of refinement. The same remark applies to the Polynesians where a 
like division exists. Ample opportunity, however, exists amongst us 
to notice the effects of the same agents on the Caucasian and Ethiopian 
races, and we are occasionally struck with the signal difference between 



MODIFIED BY PROFESSIONS, ETC. 73 

the two ; but in no case more than in the results of seclusion in our 
prisons, where the separate system is adopted. 

It is in the investigation of morbid conditions that the knowledge of 
the profession or calling is a more important topic of inquiry than in 
Therapeutics. In order to appreciate accurately, in many cases, the 
causes and seat of a disease, the nature of the daily occupation must be 
known. The flax-dresser, the glass-cutter, the needle-pointer, &c, are 
liable to diseases of the chest, owing to the minute particles given off 
in their operations entering the lungs, and exciting irritation there, so 
as to produce many and fatal pulmonary maladies. Lead, again, gives 
rise to a series of ^mptoms, which have been called, collectively, "lead 
poisoning." When a person, consequently, presents himself to the patho- 
logist, labouring under those symptoms, the inquiry suggests itself, whether 
he may not be engaged in one of those occupations in which lead is used, 
—as in smelting the metal, manufacturing sheet lead, or white lead, 
plumbing, glazing, painting, and composing in printing offices. By 
handling the metal, the carbonate of lead gets upon the fingers, and is 
swallowed, provided due cleanliness be not adopted. That this is the 
mode in which the poison of lead is often received into the system is 
shown by the fact, that at an extensive smelting establishment in Corn- 
wall, at which cases of colica pictonum were extremely common, the 
disease was almost abolished after an order had been issued, and 
rigorously enforced, that no artisan should be permitted to partake of 
food until he had washed his hands carefully with the assistance of a 
nail-brush. 

These inquiries are altogether etiological, and they afford us examples 
of the cessation of the effect after the removal of the cause. Reference 
has already been made to the fact, that although this may be the result, 
in an immense multitude of cases, the diseased action often persists 
after the removal of the cause. In the large class of diseases, that are 
symptomatic, everything depends upon the accurate investigation and 
appreciation of the primary lesion ; and this is often one of the most 
difficult points of pathological inquiry. " The greatest attention of 
the physician," says M. Begin, " is frequently required to enable him 
to discover the real causes of the disease before him. A few months 
ago I was called to a woman affected with oppression of the chest, dry 
and freqtent cough, and a painful sense of suffocation recurring at in- 
tervals ; Constant headache and vertigo; the conjunctiva injected; and 
the pulse lull, hard, and not much accelerated. For two months, her 
menses had not appeared, in consequence of a violent mental affection. 
A copious Meeding, warranted by her vigor and youth, caused a sub- 
sidence of the cerebral symptoms ; the menses re-appeared ; but the 
pectoral symptoms continued. For ten or fifteen days, I directed my 
treatment aga\nst what I considered to be irritation — either sanguineous 
or nervous — o\ the bronchia, but unsuccessfully. At last, during one of 
my visits white conversing with her I observed her executing that re- 
markable movement which accompanies difficult and painful deglutition. 
On my inquiring whether she suffered much in the same manner, she 
answered in the affirmative. I then proceeded to examine the throat : 
slight irritation existed about the pharynx and tonsils ; but the uvula 



74 THERAPEUTICAL INDICATIONS 

was elongated, filiform, and descended along the base of the tongue as 
far as the epiglottis. The true cause of the disease was disclosed. The 
exuberant appendage of the velum palati was immediately removed in 
the usual way ; and all the symptoms disappeared." 

This case is not novel, although M. Begin seems to regard it so. It has 
long been admitted, that elongation of the uvula, by irritating the top of 
the larynx, may develope the ordinary symptoms of phthisis in such as 
are predisposed to the disease ; and it can be understood, that if tuber- 
cles already exist in the lungs, it may excite them to suppuration. M. 
Begin, however, uses the case cited as the foundation for a remark, 
" that circumstances of this kind are not unfrequent. ^he physiological 
doctrine,' in unfolding the origin and nature of a vast number of symp- 
toms, heretofore considered as essential affections, has diminished the 
catalogue of diseases, and rendered their treatment more methodical and 
efficacious." The " physiological doctrine" of M. Broussais, of which 
M. Begin is a zealous supporter, was not without its good fruits; but the 
case selected by him to prove this is not a happy one. It was not the 
doctrine that attracted his attention to the uvula, but the symptoms, and 
they would equally have done so, had no " pathological doctrine" ever 
existed. The " doctrine" has been as much injured by injudicious 
friends as by open enemies ; and it is partly owing to want of discretion 
that it is now scarcely spoken of except as a matter of medical history. 

8. CAUSES, SEAT, PERIOD, &c, OF THE DISEASE. 

Enough has been said respecting the varied indications, and the 
mode of fulfilling them, according to the causes and seat of the malady. 
It need scarcely be remarked, that the period of the disease likewise 
exerts considerable influence, and is occasionally a source of diffi- 
culty to the therapeutist. In febrile diseases, the use of stimulants 
has been almost abandoned ; but cases at times occur, when they seem 
to be indicated, and the practitioner is compelled to proceed with cau- 
tion, and to decide with judgment, whether they be indicated or the 
contrary. Dr. Rush affirmed, that there was a period in fevers, when 
blisters might be had recourse to with advantage as stimulants, and to 
this period he gave the name " blistering point." If the excitement 
was above this point, blisters were improper ; if below, the contrary. 
The difficulty would manifestly be to know it. It is not fixed with ther- 
mometric accuracy ; and, consequently, the idea of the blistering point 
fell to the ground with its distinguished proposer. It will bf seen, too, 
hereafter, that blisters are by no means unobjectionable agents in the 
cases referred to by Dr. Rush as requiring the administntion of ex- 
citants. 

In inflammatory affections, the period of the disease occasions modi- 
fications, which cannot escape the observant practitioner Inflammation 
is apt to terminate in various ways, and it is important for the thera- 
peutist to determine whether such termination — as it is technically called 
— has supervened ; inasmuch as many of the ordinan signs of inflam- 
mation may be still kept up in consequence of the disordered action per- 
sisting, to a greater or less extent, in the affected tismes. Pneumonia, 



MODIFIED BY CAUSES, ETC., OF THE DISEASE. 75 

for example, may end in the effusion of a serous fluid into the lungs, or 
into the cavity of the pleura ; and this fluid may keep up irritation there. 
The excited state of vessels, too, may continue in the seat of inflamma- 
tion, though not to the same extent ; and a very different system of 
medication may be advisable from that which was adopted before such 
effusion occurred ; or at least the same activity of management may be 
altogether inadmissible. In like manner, in the inflammations of mucous 
membranes, which have persisted for a long time — or, in other words, 
have become chronic — excitant applications are made to take the place 
of the soothing, which were adopted in the earlier stages with advantage. 

Under different states or conditions of the body, remedies are found 
to produce the most varied effects. During the existence of spasm in 
any portion of the system, opium may be given in immense quantities 
without inducing its wonted action. The author has sat by the bed-side 
of a delicate female, labouring under the cholelithus means ^ of Dr. Good 
— that is, under gallstone in its progress along the biliary passages — to 
whom he has given tincture of opium by the tea-spoonful, until she took 
upwards of an ounce ; yet without any stupor following its administra- 
tion. In like manner, in neuralgia, extreme doses of narcotics may be 
demanded, as well as in mania and melancholia, delirium tremens, teta- 
nus, hydrophobia, &c. — diseases in which the cerebro-spinal and reflex 
nerves are profoundly affected, and in which the great nervous centres 
can be impressed with extreme difficulty. 

It is unnecessary to dwell upon this point. In every case of diseased 
manifestation, the mode of treatment has to be modified by the intensity, 
character and period of the affection, — whether the morbid action be above 
the medium line or below it; or, in other words, whether excitants or 
sedatives appear to be indicated from the first. 

To sum up. — It has been shown, that, amongst the most important 
circumstances, that modify the indications of cure in disease, and the 
mode of fulfilling those indications, are, — age, sex, original conforma- 
tion, habit, climate, mental affections, races, professions, and way of life, 
as well as the causes, period, and seat of the disease ; and that all these 
have to be attended to, in order that the therapeutist may be enabled 
to administer his medicinal agents with judgment and efficiency, / 



76 ACTION OF MEDICINES. 



CHAPTER III. 



OF MEDICINES. 



A medicine defined— General action of Medicines— Various modes of action — By simple, 
direct or local action — By indirect or general action — Through the nerves — Through 
absorption — Medicines divisible into Excitants and Sedatives — Classification of medicines 
— Barbier's — A. T. Thomson's — Pereira's — Author's Classification. 

A Medicine, in the enlarged sense, is any agent administered for the 
purpose of curing or allaying morbid action. The definition would 
include the different articles of diet and regimen, which are employed 
medicinally; and if we were to go into a nicety of definition, we might 
have to point out the difference between aliments, medicines, and poi- 
sons ; but this is unnecessary. The term is well understood to be 
appropriated to agents, that are had recourse to therapeutically ; or, in 
other words, to the various articles, which are received into the phar- 
macopoeias or dispensatories, or which, in consequence of their action 
upon some tissue of the body, ought to be received into them. The 
Greek word ^fiaxov signified both poison and medicine ; and the gene- 
rality of medicines are capable of exerting a deleterious agency if 
administered in too large a dose. 

Every medicinal agent — to produce its effect — must impress some 
surface of the body, and it must perhaps be capable of impressing the 
surface, whether in a healthy or diseased state. To this, however, 
some plausible objections might be urged, — both directly, and from 
analogy. For example, it is well known, that the secretions do not act 
upon the parts with which they are destined to come in contact, when 
such parts are in a state of health ; but if they become diseased, then 
the same secretions may excite violent irritation. This is exemplified 
in ardor urinae, — a term which indicates a symptom, not a disease. 
When the lining membrane of the urethra is healthy, the urine passes 
over it without exciting any uneasy sensation ; but when it is inflamed — 
as in blennorrhoea — the healthy fluid excites violent irritation, and 
such a sensation of heat as to cause the mischief to be ascribed to 
the urine ; — hence the name ardor urince — and the French chaude- 
pisse. 

An acrid condition of the bile has often been adduced as the cause 
of diarrhoea. A better pathology teaches us, that the primary source of 
irritation is usually — universally perhaps — in the lining membrane of 

the digestive tube, and that the liver is secondarily implicated ; a 

vitiated condition of the bile being very rarely, perhaps, the cause of 
bowel affections. 

Again, we have an instance in which the same remedy has very dif- 
ferent effects according to the varying condition of the organ. Most of 



MODUS OPERANDI OF MEDICINES. 77 

the believers in the abortive powers of the Ergota or ergot of rye con- 
sider it devoid of action upon the unimpregnated uterus : many of them 
think it is capable of producing abortion ; and all, that it adds to the 
efficiency of the parturient efforts, when once the process has become 
established. These, and other facts, might induce us to accord with 
Sir Gilbert Blane, and Dr. Paris, that medicines are frequently but rela- 
tive agents, producing their effects in reference only to the state of the 
living frame ; aud there is truth in the remark of Sir Gilbert, that the 
virtues of medicines cannot be fairly essayed, nor beneficially ascertained, 
by trying their effects on sound subjects, because that particular morbid 
condition does not exist, which they may be exclusively calculated to 
remove ; " thus, in certain states of debility, tonics may excite the sys- 
tem when languid, by their sympathetic influence upon the primes vice ; 
while in a robust condition of the body, the effects of the same agents 
may be wholly inappreciable." As a general rule, however, we should 
be justified in doubting the potent medicinal efficacy of any agent, which 
produces no effect whatever on the healthy body. 

1. MODUS OPERANDI OF MEDICINES. 

The modus operandi of remedies is not always clear; yet, by careful 
analysis, we can generally appreciate it — in the main results at least, — 
although we may have much difficulty in comprehending the precise 
mode in which such results are accomplished. This applies especially 
to those cases in which the agency takes place by sympathetic influence, 
— an influence proverbially obscure, and frequently invoked with the 
view of covering the ignorance of the observer ; as vitality, and organic 
action are, at times, used by the physiologist, when a function cannot 
be explained by any known physical facts or arguments. 

The modes in which the agency of remedies is exerted are chiefly as 
follows. 

a. BY SIMPLE, DIRECT, OR LOCAL ACTION. 

When a medicine is taken into the stomach, it may affect that organ 
by simple contact ; and no sensible impression may be made elsewhere. 
This is the simplest mode in which remedial agents act; and we have 
examples of the same kind in the application of caustics to parts, which 
we are desirous of eroding or destroying ; in the use of astringents in 
hsematemesis, and in cases of hemorrhoids when the remedy is applied 
so as to come into immediate contact with the affected parts ; in the 
use of collutories for sore mouth ; of external agents in ordinary local 
inflammation ; and of a poultice in suppurative inflammation. 

Inflammation, according to its degree, affords a good example of 
the mode in which disease may either be wholly local, or implicate the 
general system ; and, likewise, of the way in which our remedial agents 
may affect the frame locally or generally. In a slight case of inflamma- 
tion, we have the morbid action confined altogether to the capillaries 
implicated. The heart and larger arteries do not participate ; and the 
efforts of the practitioner are principally directed to the use of agents, 



78 



ACTION OF MEDICINES 



whose operation may be restricted to the inflamed part. But if the in- 
flammation be more severe, the whole circulatory system sympathizes, 
and remedies may be required, which act both on that system generally, 
and on the vessels more immediately concerned. At times, however, 
we see the very best results from applications, which are directed simply 
to the inflamed part; and as the increased action becomes soothed in it, 
the sedative influence is propagated to the rest of the system, as the 
morbific influence was in the first instance. In cases of inflammation 
of the conjunctiva, a few drops of a weak solution of nitrate of silver, 
thrown on the eye, often allays the irritation almost instantaneously, and 
the increased action of the vessels communicating with the over-dilated 
capillaries speedily subsides ; but if, on the other hand, a very strong 
solution of nitrate of silver, or of any other astringent, be dropped on 
the diseased eye, it may excite intense irritation there ; and the vascu- 
lar apparatus of the part, and even of the whole system, may be thrown 
into a state of turmoil. If we, then, soothe by appropriate applications, 
the turmoil ceases. ) 

In these last cases, we have examples, not only of the purely local 
or direct action of medicines ; but also of the extension of this action 
elsewhere, — constituting the next mode of operation. 

b. BY INDIRECT OR GENERAL ACTION. 

This is the mode commonly adopted in the administration of remedies. 
In most cases of internal exhibition, the agent must first come in con- 
tact with the stomach, and, through this organ — the great " centre of 
sympathies," as it has been long considered, and designated— other 
parts become impressed, according to the elective affinity of the parti- 
cular article for some tissue or organ rather than for" another. It is owing 
to the stomach being so intimately associated with other parts, that it 
is generally chosen as the organ, through which remedies are to act. If 
its functions be disordered, as in dyspepsia, the whole system sympa- 
thizes : there is not an organ that does not feel the depressing irradia- 
tions ; the brain and nervous system may become so disordered that the 
patient is subject to all kinds of hallucinations; and hypochondriasis 
thus becomes a common concomitant of dyspepsia. Nauseating remedies 
exert their effect on the whole system, through the stomach, so as to 
be valuable agents in diseases of increased action ; and, in short," as the 
different parts of the system can be affected by impressions conveyed, 
through the stomach ; — so, conversely, no irritation can persist for any 
great length of time in any organ without the stomach participating ; 
hence it is, that it has been designated * the centre of sympathies.' 

The manner in which this indirect effect of medicines is induced is 
as follows : 

1. Through the Nerves. 

Between every part of the system of nutrition there is the greatest 
sympathy or consent ; so that if any one be inordinately and irregularly 
excited, others at a distance sympathize ; and this to a greater or less 



THROUGH THE NERVES. 79 

degree, according as such parts are more or less disposed to take upon 
them, at the time, a similar derangement. This is seen when the feet 
are exposed to cold and moisture ; derangement takes place in the func- 
tions of the capillaries of the feet, and this derangement is reflected to 
every part of the system of nutrition, so that in a dozen individuals ex- 
posed to this cause of disease, the derangements may be as various in 
their seats as are the individuals themselves ; owing to ftie greater pre- 
disposition of some particular organ to assume a morbid action in one 
rather than in another. Now, that which applies to the external surface 
applies equally to the internal expansion of the skin forming the mucous 
membranes, so that medicines received into the stomach, by impressing 
the tissues of that organ, may produce sympathetic results on parts at a 
distance. 

That medicines do exert their influence through the nerves — as one 
modus operandi — has seemed to be unquestionable. M. Dupuy divided 
the pneumogastric nerves in a horse, and then introduced two ounces 
of nux vomica, in the form of a bolus, into the stomach. No unplea- 
sant consequences followed; whilst another horse — equal in size and 
strength to the former — to which the same quantity of the poison w T as 
administered, died in a few hours in violent tetanic convulsions. It is 
probable, that the reason why the former did not suffer was the division 
of the nerves; but a doubt might be raised, with much plausibility in 
its favour, whether it was directly dependent up n such division, or in- 
directly, owing to the function of absorption having been suspended by 
the section. The researches of modern toxicologists have appeared to 
furnish us with cases that are unequivocal ; one of which is sufficient 
for the purpose. If strong hydrocyanic acid be applied to the tongue 
of an animal, it dies so rapidly, that there may be scarcely time enough 
to remove it from the lap of the experimenter before life has ceased. 
In this case, it would seem to be almost impossible for the poison to 
have entered the blood-vessels, and to have passed, with the current of 
the circulation, to the great vital organ on which its deleterious agency 
is exerted. The well devised and carefully conducted experiments of 
Professor Blake, of Saint Louis, shew, however, that in the case of this 
poison, as of every other, the velocity of the circulatory current is so 
great as to enable us to comprehend, that the deadly influence may be 
exerted in all cases by the reception of the poison into the blood. He 
found, that sufficient time always elapses between the application of the 
poison and the first evidences of its action to admit of such contact. 
In a recent experiment on a rabbit with hydrocyanic acid, the animal, 
immediately after the contact of the acid with the lining membrane of 
the mouth, jumped from the table, and when on the floor of the room 
was perfectly able to stand on its feet. At two seconds and a half after 
the application of the poison, it fell on its side; and was dead in five 
seconds. " This," he remarks, " is but one of many experiments which 
have been performed on cats and rabbits, and in no instance have I ob- 
served instantaneous death, or even the instantaneous action of the 
poison." 

So far as Dr. Blake's experiments go, they are certainly favourable 
to the possibility of the action of all poisons by absorption ; yet grant- 



80 ACTION OF MEDICINES 

ing the velocity of the circulation to be such as described by him, and 
that a substance injected into the blood-vessels of an animal may be 
diffused through the circulatory system in nine seconds ; it is difficult 
to conceive — as in the experiment mentioned above — that hydrocyanic 
acid should be absorbed and diffused so as to cause the animal to fall 
on its side in the short space of two seconds and a half after its appli- 
cation ; or to admit with Dr. Pereira, in the third edition of his valuable 
work recently published, that the experiments of Dr. Blake have given 
the coup-de-grace to the hypothesis of the action of medicines and poisons 
through the nervous system. Dr. Blake himself, indeed, goes no farther 
than to consider it "but reasonable to suppose that many, if not most" 
of our remedial agents modify the animal economy by entering into the 
blood, "and that, therefore, in the scientific investigation of the action 
of medicines, a point of the greatest interest is, to endeavour to ascer- 
tain the effects produced on the blood by the substances that are thus 
mixed with it, and also the changes produced on the tissues of the body 
by their contact with the substances that are thus brought to them ;"~ and 
he subsequently adds — M but whilst at the same time, that I believe, that 
a great many of our medicines act when taken into the blood, and through 
changes produced in that fluid, yet I think the exclusive doctrine of the 
humoral action of medicines would be as ridiculous as that which 
supposes, that when a man sneezes after taking snuff, or has an attack 
of epilepsy from irritation in any other part of the raucous membrane, 
that the sneezing and the epilepsy are the result of changes produced in 
the blood." 

Several of our medicinal agents, it will be found, act by preference 
on the nervous system, and of these all do not act upon it in the same 
way. Opium affects the brain, causing stupor ; strychnia, the brain and 
spinal marrow, producing tetanic convulsions ; and prussic acid excites 
coma with tetanus. The precise ground of these differences is inscru- 
table; yet that they exist cannot be denied. There is a manifest affinity 
between particular remedial agents, and particular parts of the frame ; 
and in whatever manner these agents are administered — whether by the 
stomach, or by the skin, or by infusion into the blood — they seek out 
the organs on which they act by preference ; yet, why tartrate of anti- 
mony and potassa should produce vomiting, when injected into the 
venous system, and rhubarb purge — why such elective affinity should 
exist — is unknown. 

We can likewise affect distant parts by applying our remedial agents 
to the cutaneous surface. Reference has been made to the effect, pro- 
duced on the system elsewhere, by the irregular action induced through 
exposure of the feet to cold and moisture. The effect of ablution, as 
a refrigerant, in fever, is another example. If the skin be steadily hot 
and dry, cold or tepid water may be applied by washing or sponging, 
so as to diminish greatly the morbid heat ; and, accordingly, it is one of 
the most valuable febrifuge remedies that we possess. The capillary 
system, to which the cold or tepid fluid is indirectly applied, has its 
action diminished, and, through that extensive sympathy, which has 
been mentioned as existing between every part of the system of nutri- 
tion, the sedative influence is speedily extended to the rest of the frame. 



THROUGH THE NERVES. 81 

It is to the external surface that most of our energetic counter-irritants 
or revulsives are applied ; although we shall find, that various local 
stimulants, administered internally, are indebted, for much of their effi- 
cacy, to the derivation or revulsion they occasion. 

Dr. Thomson regards the organ of smelling as a third medium for 
receiving the impression of medicinal agents on the nervous system : 
the effect, he remarks, " is chiefly produced on the first and the fifth 
pairs of nerves distributed over the schneiderian membrane lining the 
nostril, the adjoining sinuses, and the convoluted bones, so beautifully 
contrived to extend this surface in a limited space ;" and he adds, that 
" many substances, which are supposed to enter the system by pulmo- 
nary absorption, such as the fumes of alcohol, tobacco, and ammonia, 
affect the habit solely by impressions made on the nerves of smelling." 
In support of this opinion, he quotes numerous experiments by Dr. Rous- 
seau, of Philadelphia, which appeared to warrant the conclusion, that by 
simply closing the nostrils, either by compressing them with the fingers, 
or by stopping them, the fumes of ardent spirits, or of a strong decoc- 
tion of tobacco, or an infusion of opium might be inhaled for an hour, 
without any unpleasant effect ; whereas if these precautions were omit- 
ted, the consequences were found to be most distressing. Notwith- 
standing, however, the mode in which these results are stated, the author 
cannot help doubting the accuracy of the experiments; and, of neces- 
sity, the deductions founded upon them. When substances are inhaled, 
either by the nose or the mouth, they come in contact with branches of 
the fifth pair of nerves. In the nose, it is true, they impinge also upon 
the ramifications of the first pair or the olfactories; but, on the other 
hand, in the throat, they meet with branches of the glossopharyngeal 
and pneumogastric. It is admitted, that more effect is produced on the 
nervous system, when they are passed through the nose, than when they 
traverse the mouth ; but this is perhaps owing to the greater degree of 
velocity with which they are made to enter the former than the latter 
cavity, so that the nasal nerves are more powerfully impressed than the 
buccal, and — as the supporters of absorption would say — their entrance 
into the circulation through the mucous membrane is rendered more 
ready ; but it is not necessary — as Dr. Thomson thinks is the general 
belief — that such absorption should be pulmonary. All the mucous 
membranes are absorbing surfaces, and although a portion of the fumes 
may pass, along with the inspired air, into the ultimate bronchial rami- 
fications, and be there absorbed, imbibition takes place in every part of 
the mucous membrane, from the place where it commingles with the 
skin of the mouth to the point of termination of the minute air-tubes. 
Nor was the author aware, that any one entertained the opinion, that 
ammonia enters the system by pulmonary absorption. As well might 
it be presumed, that any inorganic and mechanical excitant, applied to 
the nasal nerves, exerts its agency by such absorption. 

Of the precise mode in which medicinal agents influence the nerves, 
we know little or nothing. It is not necessary, that the surface, w T ith 
which they come in contact, should be physically modified, or any 
organic change be perceptible. In the case of the almost instan- 
taneously fatal application of hydrocyanic acid there is no time for the 
Vol. I.— 6 



82 ACTION OF MEDICINES 

supervention of organic modifications in the part with which it comes 
in contact. The lethiferous influence is at once exerted, and if through 
the nerves— which it has been seen— may well be questioned, irradia- 
tions must proceed along them to one or other of the great vital centres, 
whose action ceases on the instant, and immediately afterwards that of 
every co-ordinate and tributary organ. 

The mode in which the influence of medicines is extended to different 
organs, through the nerves, probably differs. In' many cases, the im- 
pression made upon the part to which the agent is applied passes im- 
mediately to the brain, and is thence reflected to the sympathizing 
organ. This is probably the way in which medicinal agents generally 
produce their effects through sympathy ; but in certain cases it would 
seem that this reflection is not indispensable. A demulcent, by passing 
over the top of the larynx^ produces a soothing influence there, which 
may extend to other parts of the pulmonary mucous membrane, by 
what is termed sympathy of continuity, effected perhaps through con- 
tinuous nerves. In the same manner, the action of a suppository, or of 
a glyster, excites the upper parts of the intestinal tube to contraction. 
Physiology and pathology furnish multitudes of examples of this kind 
of sympathy, as well as of the sympathy of contiguity, of which we 
have an instance, where the muscular coat of the intestines is aroused 
to increased action by the irritation of a cathartic on the mucous coat; 
or, where we attempt to produce an emmenagogue effect by the adminis- 
tration of cathartics — such as the preparations of aloes — whose action 
is mainly exerted on the lower part of the bowels. The generality of 
physiologists of the present day look to the nervous system as the great 
source and medium of communication of the different irradiations by 
which distant organs are supposed to react sympathetically upon each 
other. The rapidity, indeed, with which the various actions of the 
nervous system are executed, — the apparent synchronism between the 
reception of an impression on an organ of sense, and its perception by 
the brain, as well as between the determinations of the will and their 
effect upon a muscle, — naturally attracted the attention of physiologists 
to this system as the instrument of sympathy ; and we certainly know 
enough to infer, that, in many cases, in animals, the nerves appear to 
be the conductors ; that the brain is, in others, the centre, to which the 
organ in action transmits its irradiations, and by which they are reflected 
to the sympathizing organ ; whilst, in others, again, the effect is caused 
in the absence of a nervous centre, and perhaps even of nerves, in a 
manner, which, in the present state of our knowledge, is inexplicable. 
It is not difficult, however, to conceive, that by means of contractility, 
impressions — vibratory or other — may pass rapidly from one part of the 
organism to another, as they do in the vegetable, which — if we admit 
it to be possessed of a nervous system at all — has it in a primitive and 
rudimental form, and has certainly nothing like a nervous centre for the 
reflection of impressions. Vibrations, it is well known, communicated 
through the air from a sonorous body when struck, impress the oro-an of 
hearing: light probably acts in a similar manner upon the visual Appa- 
ratus ; and we may suppose, without any violence to probability, that 
a similar vibration may exist over the organism, so that an impression 



THROUGH REVULSION. 83 

made upon one part may rapidly oscillate to another, independently of 
any thing like nervous communication. 

It must be essentially in this way that medicinal agents exert their 
efficacy, by revulsion or derivation. It is a general rule in the animal 
economy, that two diseased actions do not readily go on at the same 
time with the like degree of intensity. This has been the subject of 
remark for ages, and for all ages ; and many popular remedies have 
been suggested by a knowledge of the fact. When any morbid action 
is going on in the system, and a new source of irritation is artificially 
excited, it often happens, that the new irritation, by attracting the ner- 
vous and vascular afflux to it, detracts or derives from the internal 
morbid action, so as to diminish, or wholly remove it. It is in this 
way, that blisters, and the various counter-irritants, issues, setons, 
moxas, &c, produce their beneficial effects, not by the discharge which 
they occasion. Hence, too, it is, that benefit results from a popular 
remedy, — the application of a garlic poultice to the thumb in cases of 
toothache. But these are only marked examples of revulsion. It ac- 
companies, likewise, the action of every local stimulant. It follows the 
the use of cathartics, and is the way in which their chief remedial agency 
is, in many cases, exerted. In head affections, especially in apoplexy, 
a revulsion, thus effected, is often most salutary ; and for this purpose, 
when deglutition is impracticable, and even when not, powerfully stimu- 
lating euemata are thrown into the rectum with advantage. In like 
manner, the milder cathartics may be productive of benefit in gastro- 
enteritic affections by the succession of sympathies, which they induce, 
in passing over the different tracts of the intestinal canal. Diuretics, 
and in short, as already remarked, all local stimulants owe a part of 
their efficacy to revulsion ; and some of the most valuable agents we 
possess in the treatment of protracted disease, — as mercury and iodine, 
i — are often employed with no other view. The avowed object of the 
practitioner is to excite a new action ; or in other words to produce, 
artificially, a new condition of the system of nutrition, which may re- 
move that previously existing. 

The doctrine of revulsion reposes on the received belief, that diseases 
are cured by remedies that are counter to them, — " contraria contrariis 
medentur ;" but an imposing medical sect has attempted, and is at- 
tempting, to overthrow this doctrine, and to set up the opposite, — 
" similia similibus medentur." The ' Homceopathists' maintain, that 
there are remedial agents, which can produce symptoms similar to those 
of disease, and that every dynamic affection of the living organism can 
be destroyed by another of still greater intensity, and permanence, that 
strongly resembles it. They maintain, indeed, that the curative virtues 
of medicines are solely dependent upon the resemblance their symptoms 
bear to those of the disease. There are but three modes, they affirm, of 
applying medicines in disease ; first, the homoeopathic ; secondly, the 
allopathic or heteropathic, — the method in general use, which is said by 
them never to regard that which is really diseased in the body, but to 
attack parts that are sound, in order to draw off' the malady from an- 
other quarter, and direct it towards the latter; and thirdly, the anti- 
pathic, enantiopathic or palliative : by which method they affirm, phy- 



84 ACTION OF MEDICINES 

sicians have, till the present time, succeeded in affording apparent 
relief, and gained the confidence of their patients, by deluding them 
with a temporary suspension of their sufferings. 

Upwards of a quarter of a century ago, Samuel Hahnemann— -the 
founder of the " homoeopathic medical doctrine ;"— first propounded his 
opinions in the authoritative form ofthe"Organonderrationellen 
H e i 1 k u n d e"— " Organum of rational medical science." The book 
was issued from the Dresden press, but did not at first attract much 
the attention of physicians. In 1819, a second edition appeared, under 
its present title,— the epithet r a t i'o n e 1 1 e n or ' rational,' haying been 
omitted. Since that time, it has passed through different editions, and 
the English reader, who is not a German scholar, is now enabled to 
peruse it through the medium of a translation by Mr. Devrient, with 
notes by Dr. Stratten of Dublin. 

It is not the author's intention to inquire into the principles and claims 
of this fantastic doctrine at any length ; but a few observations may be 
appropriate. Cinchona appears to have been the first drug experimented 
with by Hahnemann. Whilst occupied in translating the Materia Me- 
dica of Cullen into German, he was dissatisfied with the explanation of 
the febrifuge powers of that drug, and determined to make trials upon 
himself. He took it in considerable quantity, while in perfect health, 
and found it produced symptoms like those of ague. Hence, he in- 
ferred, that intermittents are removed by cinchona, in consequence of 
its exciting in the system a morbid condition, similar to that for the 
removal of which it is administered. 

Again ; say the homceopaihists, — mercurial preparations, when ad- 
ministered internally, produce symptoms — local and constitutional — so 
closely resembling those of syphilis, that medical practitioners, who have 
spent, years in the investigation of that disease find it difficult, and in 
some instances impossible, to distinguish one affection from the other. 
If the venereal poison produces pustules, scales and tubercles, mercury 
does the same. If syphilis is attended with inflammation of the perios- 
teum and caries of the bones; so is the action of mercury. "Inflam- 
mation of the iris from lues," says Dr. Stratten, " is an every day 
occurrence ; the same disease is a very frequent consequence of mer- 
cury. Ulceration of the throat is a common symptom of syphilis : the 
same affection results from mercury. Ulcers on the organs of reproduc- 
tion are the result of both the poison and the remedy ; and furnish an- 
other proof of the doctrine similia similibus. Nitric acid is generally 
recommended in cutaneous diseases; the internal use of this remedy, 
in a very dilute form, produces scaly eruptions over the surface of the 
body ; and the external application of a solution, in the proportion of 
one part acid to one hundred and twenty-eight parts water, will produce 
inflammation and ulceration of the skin. These observations would 
lead to the conclusion, that nitric acid cures cutaneous diseases, by the 
facility it possesses of producing a similar disease of the skin. Nitrate 
of potash, administered internally, in small doses, produces a frequent 
desire to pass water, accompanied with pain and heat. When this state 
of the urinary system exists as a consequence of disease, or the applica- 
tion of a blister, a very dilute solution of the same remedy has been 



THROUGH REVULSION. 85 

found beneficial. The ordinary effects of hyoscyamusniger are vertigo, 
delirium, stupefaction, and somnolency. Where one or other of these 
diseased states exists, it yields to small doses of the tincture of this 
plant. The internal use of hyoscyamus is followed by mental aberration, 
the leading features of which are jealousy and irascibility. When 
these hallucinations exist, this remedy is indicated. Opium, in general, 
causes drowsiness, torpor, and deep sleep; and yet this remedy, in 
small doses, removes these symptoms when they occur in disease. Sul- 
phur is a specific against itch; notwithstanding which, when it is ad- 
ministered to healthy individuals, it frequently excites a pustular eruption 
resembling itch in every particular." 

Dr. Stratten asserts, that these deductions are drawn from actual 
experiment ; and so, we are told, are all the positions advanced by the 
homoeopathists. 

The doses of medicines administered by them are infinitesimally 
small ; the decillionth degree of dilution is not uncommon. The follow- 
ing extract from Hahnemann's treatise on chronic diseases will show to 
what an extent the farce is carried. 

" Of homoeopathic medicines, tak%one grain of those which are solid, 
(mercury being included in the number,) or one drop of those which are 
liquid; put this small quantity on about the third part of a hundred 
grains of pulverized sugar of milk in a porcelain capsule that is not 
glazed ; then mix the medicine and the sugar of milk together for a 
moment, with a spatula of bone or horn, and pound the whole strongly 
during six minutes. The mass is then detached from the bottom of the 
capsule and pestle during four minutes, in order that it may be perfectly 
homogeneous, and then rub down afresh during six minutes with equal 
force. Collect the. whole of the powder into a body during four min- 
utes, then add the second third portion of the sugar of milk, and mix 
the whole for an instant with a spatula ; then triturate with force during 
six minutes. This is to be once more scraped together during four 
minutes, and rubbed again for six minutes. Stir the whole together 
during four minutes, and add the last third portion of the sugar of milk, 
which is to be mixed by turning it about with the spatula ; then triturate 
the mass powerfully during six minutes, scrape it together during four 
minutes, and the whole is finally to be rubbed down for six minutes. 
After the powder has been carefully detached from the capsule and 
pestle, put it into a phial, and let it be corked and labelled with the 
name of the substance, and the mark Too, which shows that the sub- 
stance is in the hundredth degree of attenuation. To carry the medicine 
to the ten thousandth degree of attenuation, take one grain of the pow- 
der marked lob, prepared as above, add the same to the third part of an 
hundred grains of pulverised sugar of milk, mix the whole in the capsule, 
and proceed in such manner, that after having triturated each third por- 
tion with force during six minutes, scrape the mass together during a 
space of four minutes. The powder, when thus prepared, is put into a 
well corked bottle with the figures fojbob marked on the exterior, which 
will point out its degree of attenuation. The same method is observed 
when this second powder marked lojoob is to be carried to the millionth 
degree of attenuation," &c, &c. 



86 



ACTION OF MEDICINES 



The homoeopathic method can only be regarded as a branch of the 
expectant stem ; and it is liable to every objection that applies to the 
latter. The homoeopathists argue, however, that inasmuch as very 
small portions of a chemical substance can be detected in a solution, so 
may minute portions be capable of impressing the organism. For ex- 
ample — say they — one grain of nitrate of silver, dissolved in one thou- 
sand five hundred and sixty grains of distilled water, will yield an 
evident gray precipitate, perceptible in every part of the fluid, when two 
grains of chlorohydric acid are added to it ;-t-and again ; when one grain 
of iodine is dissolved in a drachm of alcohol, and mixed in the same quan- 
tity of distilled water as in the last case, and to this two grains of starch, 
dissolved in an ounce of water, are added, an evident blue tint is pro- 
duced in the solution. In these experiments, consequently, the grain of 
the nitrate of silver and iodine must have been divided into one-fifteen 
thousand two hundred and sixtieth of a grain. These experiments, 
however, are in no wise elucidative of the position ; — for although such 
minute portions of chemical agents may be detected by the senses, it by 
no means follows, that they can exert a remedial action. Accordingly, 
it is affirmed by M. Andral and others, that when the homoeopathic sys- 
tem has been impartially tried, it has not been found to succeed in the 
manner asserted by its supporters. Like the expectant method in gene- 
ral, it is totally inefficient in acute cases ; but, like it, where advantage 
is to be derived from trusting to that recuperative power, which, we 
have seen, is seated in all living bodies, and is too much neglected, 
its adoption is beneficial. This is one of the useful lessons, which the 
system aids in teaching. Another, perhaps, is, — the propriety, now uni- 
versally admitted, of simplicity in our prescriptions, — in consequence of 
the greater or less uncertainty that must often exist-— ,where two or more 
agents are thrown together— whether they may not mutually modify 
each other's action. The homoeopathists believe, that every disease 
carries with it a greater susceptibility for the proper medicine ; and ac- 
cordingly, they lay down the rule, that only one simple medicine should 
be administered to the sick at a time. 

One of the strangest of the assertions of Hahnemann and his followers 
is — that homoeopathic medicines acquire at each division or dilution a 
new degree of power, by the rubbing or shaking to which they are sub- 
jected, " a means," says Hahnemann, " of developing the inherent 
virtues of homoeopathic medicines that was unknown till my time; and 
which is so energetic, that latterly I have been forced, by experience, to 
reduce the number of shakes to two, of which I formerly prescribed ten 
to each dilution"! !* 

Yet homoeopathy, with all its absurdities, enables us to deduce 
rational and important inferences. Which of us could credit that if we 
take a grain of flint or charcoal, mix it with as much sugar as could be 
contained in the hold of a line of battle ship, and give a grain of this 
that it could exhibit any « potency,' and a fortiori that smelling at this 

• Hahnemann's words are :-«< dass ich in den letztern .Tahren durch iiberzeugende Erfah- 
rung genothigt ward, die ehemals vorgeschriebenen zehn Schuttelschliige nach ieder Verdiin- 
nung bis auf zwei einzuschriinken — Organon der Heilkunst, % 280. 



THROUGH ABSORPTION. 87 

infinitesimal quantity of a powerless agent could possess any curative 
property ? Yet the homoeopathist professes to believe this ; and the 
dose is even large for him. But if we reflect, that diet is carefully 
attended to ; and that an air of mystery is thrown around the new light, 
whilst the instinctive actions are not interfered with by powerfully dis- 
turbing influences, we can as readily understand, that a large mass of 
chronic diseases may yield to it, — especially when occurring in those 
of nervous and excitable temperaments, and whose faith and confidence 
are freely given to novel agencies, particularly when shrouded in mys- 
tery, as that the same class of affections should have yielded to the cere- 
monies in the ancient temples. The investigation of this subject has 
indeed led a distinguished, bold and independent searcher after truth, 
and an elevated member of the profession, Dr. Forbes, to deductions 
strikingly analogous to those which the author has for many years 
promulgated. Animadverting, in forcible language, on the absurdity 
of the doctrine which teaches that the decillionth of a grain of char- 
coal or oystershell is capable of producing hundreds of the most 
formidable symptoms, and of curing, as by magic, the most inveterate 
diseases, whilst we can take ounces, nay pounds, of the very same 
substance into our stomachs with no other inconvenience than its 
mechanical bulk, — and stating, that this " seems so gratuitous an 
outrage to human reason, that the mind instinctively recoils from the 
proposition," — he philosophically inquires into the alleged cures by 
the homceopathists, and arrives at the just conclusion, " that the cura- 
tive powers of nature suffice to explain all the triumphs of homoeo- 
pathy ; when we take into consideration other agencies which are at 
the same time brought to bear ; — as the much stricter regulation of 
the diet and regimen, including the entire omission of vinous and 
other stimulants; the influence of the imagination, stimulated by pre- 
vious belief in the potency of the remedies prescribed, and nourished 
by fervent faith, hope, &c, and by the indirect influence of this faith,' 
hope, &c, in inducing patience, so that time is allowed for nature to 
work the cure in her own way." Homoeopathy has certainly tended to 
impress upon us still more strongly the well known, but too often over- 
looked, truth, that all diseases do not require the employment of ener- 
getic disturbing agents ; and that many of them will proceed more satis- 
factorily towards health under judicious hygienic cares without the 
assistance of any medicine. Rational therapeutics has, therefore, bene- 
fitted by homoeopathy, notwithstanding the follies of the doctrine, whilst 
it may be admitted, that in special cases evil has resulted from the 
exclusion of greater energy of treatment. 

2. Through .Absorption. 

The proofs, that medicines may be absorbed from the alimentary 
canal and elsewhere, in their entire state, are as numerous as they are 
satisfactory. It is but necessary, that a substance should possess the 
requisite tenuity to soak through the coats of the veins, and, in this 
way, get into the circulatory current. The facts and arguments, con- 



88 ACTION OF MEDICINES 

nected with the absorbent function of the veins, are so fully detailed in 
the author's ' Human Physiology,' that a simple reference to them here 
will be all that is necessary. Few physiologists of the present day doubt, 
that those vessels are capable of this function ; yet it is denied by one 
therapeutical writer, Professor Chapman, of Philadelphia, that medi- 
cines can pass unchanged into the venous system, or, in other words, 
that they can be absorbed in their entire state : the assertion and belief 
are designated by him as a " relict of the humoral pathology ;" and he 
affirms, " that it must at least be acknowledged, that no substance in 
its active state does reach the circulation, since it is shown, that a small 
portion, even of the mildest fluid— as milk, or mucilage, oil, or pus— 
cannot be injected into the blood-vessels, without occasioning the most 
fatal consequences." 

Setting aside the multitude of facts, which show, that substances may 
be absorbed by the veins, and be detected by chemical re-agents in the 
blood, we know well, that they can be injected directly into the vessels 
without producing death ; and that, since the time of Harvey until the 
present, the " infusion" — as it has been termed — of medicinal agents 
into the blood has been a common practice. It is asserted to have been 
first employed about the middle of the seventeenth century, and it has 
been practised at the veterinary school of Copenhagen, with complete 
success, — the action of the remedy being more speedy, and the dose 
required much less, when thus administered. Experiments of this kind 
have confirmed the well known but singular fact — already referred to 
— that medicinal substances exert their action by preference upon cer- 
tain parts of the body, in the same manner as if they had been received 
into the stomach. Tartrate of antimony and potassa vomits, and castor 
oil purges, not only as certainly, but with much greater speed ; for, 
whilst the former requires to be in the stomach for fifteen or twenty 
minutes before vomiting is excited, it produces its effects in two or three 
minutes when thrown into the veins. Of late years, the custom has 
been, in certain diseases and in numerous experiments, to load the 
blood-vessels with warm water so as to induce a state of preternatural 
fulness ; and, in cholera, the quantity of saline solution injected has been 
enormous. The great, the necessary, precaution appears to be, that the 
fluid should not be too viscid ; for it has been found, that thick fluids, 
such as oil, or mixtures of powders, are unable to pass through the pul- 
monary capillaries, in consequence of which the circulation is arrested, 
and death follows : and within these limits the remark of Professor 
Chapman is correct. Such was the result of several experiments on 
animals with powdered substances, undertaken by an enthusiastic physi- 
cian of Boston — Dr. E. Hale, Jr., — who had nearly fallen a victim to an 
experiment of the kind instituted on himself. Dr. Hale, desirous of 
observing the effects of castor oil when thus injected, attempted to pass 
it into a vein of the arm ; he experienced, however, considerable diffi- 
culty in introducing it, and to this his safety has been ascribed. Soon 
after the injection he felt an oily taste in the mouth, which continued for 
a length of time, and the medicine produced great gastric and intestinal 
disturbance. 

Again ; — much depends upon the mode in which the injection is sent 



THROUGH ABSORPTION. 89 

in, — as regards velocity. If a drachm of healthy bile be suddenly thrown 
into the femoral vein in a state of concentration, death soon follows ; 
but if it be suffered to pass in very slowly, little or no inconvenience 
results. It was the opinion of Bichat, that if a bubble of air should 
accidentally enter the venous system, it would cause death ; but the ex- 
periments of MM. Nysten and Magendie have shown, that if it be intro- 
duced slowly, no unfortunate event need be apprehended. It is a cause 
of death after severe surgical operations, although it is not much more 
than a quarter of a century since the ratio moriendi, in such cases, was 
first suspected. Some animals admit enormous quantities of air into 
the veins without perishing. M. Magendie instances the case of a horse, 
into whose veins he sent, as rapidly and forcibly as he was able, forty 
or fifty pints of air without occasioning immediate death, although the 
animal ultimately expired; and M. Lepelletier de la Sarthe alludes to simi- 
lar experiments of his own ; from which he infers, that the fatal action 
of the air is mechanical, and that it is possible to prevent the result by 
injecting so gradually, that the blood has the power to disseminate, and 
perhaps even to dissolve the gas, with sufficient promptitude to prevent 
its accumulation in the cardiac cavities. No doubt, then, ought to exist, 
that medicines can be absorbed from the stomach or elsewhere in their 
entire state, and that when once in the circulation they may affect the 
great nervous centres, or proceed with the current to act on those organs 
for which they have a special affinity. 

It would seem, moreover, that many remedial agents may act in a 
purely physical manner, by influencing the phenomena of endosmose. 
When the serum of the blood is separated from another liquid by means 
of an organic membrane, two currents are established through the mem- 
brane — the one from the serum to the liquid ; the other from the liquid 
to the serum. As a general rule, very concentrated solutions of salts 
were found by M. Poiseuille to cause greater endosmose of the serum, 
whilst dilute solutions gave rise to endosmose of the solution ; and for 
solutions of a certain intermediate strength, the two currents were equal. 
On the other hand there are substances, as muriate of morphia, whose 
presence arrests endosmose. 

The application of these facts to the action of medicines is full 
of interest. M. Poiseuille found, that there was endosmose through 
animal tissues from the serum of the blood to Seidlitz water, and to 
solutions of sulphate of soda and common salt ; and this is known 
to occur when these substances are used as medicines ; — the evac- 
uations always containing a considerable quantity of albumen. In 
such case, endosmose takes place from the serum of the blood in the 
capillaries of the intestines to the saline solution in the alimentary 
canal. 

Another remarkable phenomenon, observed by M. Poiseuille and con- 
firmed by M. Bacchetti, is the influence exerted by muriate of morphia 
on an organic membrane. When this salt is added to a saline solution, 
it greatly weakens endosmose from the serum to the solution, and ulti- 
mately reverses the direction of the current. To this endosmotic influ- 
ence, MM. Poiseuille and Matteucci are disposed to ascribe the efficacy 
of morphia and opium in checking diarrhoea and the cathartic effects 



90 ACTION OF MEDICINES 

of other substances, as well as in causing constipation ; and it, doubt- 
less, ought not to be wholly overlooked in accounting for the pheno- 
mena. 

Substances may be absorbed from the cutaneous surface, although 
this is infinitely less easy than from its prolongation, which constitutes 
the mucous membranes. The cuticle is a great obstacle to absorption ; 
for if it be removed in any manner, so that a substance, capable of 
absorption, can come in contact with the vessels of the corpus papillare, 
absorption takes place readily. The same thing happens— to a more 
limited extent — if we force the substance by friction through the cuticle. 
This is the mode in which we affect the system by means of mercurial 
unguents. We select a part of the body where the cuticle is thinnest, 
and continue the friction until the globules of mercury disappear, or 
until it has been forced through the cuticle into contact with the corpus 
papillare. The most undoubted evidence exists, that mercury enters the 
blood. Dr. Colson detected it by introducing plates of polished brass 
into the blood, which became covered with a coating of mercury ; and 
Dr. Christison affirms, that it has been obtained from the crassamentum 
of persons salivated, when no mercury could be detected in the serum. 
Many such cases have been recorded. Moreover, by means of the mi- 
croscope, Dr. Oesterlen detected minute globules of mercury in the tis- 
sues, in the blood, and in the secretions of men and animals to whom mer- 
curial ointment had been given internally, and applied by frictions to the 
skin. 

The method of administration by friction is called the iatraleiptic : 
the one which consists in placing remedies in contact with an abraded 
or vesicated surface, the endermic. The latter method has been chiefly 
employed in recent times ; and it has been advised where it was con- 
ceived that digestion would interfere with the action of the drug, — a 
succedaneum, which, according to the peculiar views of Professor 
Chapman, would be wholly inoperative, inasmuch as he considers every 
section of the absorbent system to be endowed with the power of di- 
gestion and assimilation, and the lymphatics quite as conspicuously as 
the lacteals ; this he regards as a provision of nature to exclude noxious 
matters from the circulation, — an opinion which is a necessary pendant 
to his views regarding the mode in which substances enter the vessels. 

Medicines may likewise be received into the system in, in their entire 
state, by the lungs. The whole of the respiratory apparatus is lined by 
a mucous membrane resembling that of the digestive passages, and as 
the substances, which enter the air tubes, are extremely tenuous, they 
can pass with facility into the blood-vessels. The different respirable 
gases produce their effect in this way ; and hence the hilarity caused by 
the protoxide of azote or the " laughing gas ;" the anaesthesia from the 
inhalation of ether and chloroform ; and the exciting or depressing in- 
fluences produced by inhaling appropriate gases. 

Reference has already been made to the opinion of Drs. Rousseau and 
Thomson, that ardent spirits exert their intoxicating influence by im- 
pressing the nasal nerves ; but it is more probable that much of the 
intoxicating effect produced on those who pump ardent spirits from large 
casks into small vessels, in extensive wholesale establishments, is owing 



THROUGH ABSORPTION. 91 

to the vapour of the alcohol entering the lungs with the inspired air, 
and being imbibed by the pulmonary vessels. It is doubtless in this 
way, that miasmata — both terrestrial and animal — exert their influence ; 
— their first impression being made either on the nerves distributed to 
the coats of the pulmonary blood-vessels, or on the nervous centres, 
when carried thither with the circulatory fluid. The rapidity with which 
the effects are exhibited, when a person, who — owiijg to previous attacks 
of malarious disease, has been rendered unusually susceptible to the 
action of miasmata — is subjected to their influence, is surprising. 

Thus far attention has been directed to the absorption of medicinal 
substances in their entire state. It often happens, however, that they 
are decomposed prior to, or after entering the circulation. One writer 
on Therapeutics, already cited — Professor Chapman — has, indeed, sup- 
posed, that in all those cases in which salts appear to have entered the 
blood in their entire state they are decomposed in the stomach ; that 
their components enter the circulation under the influence of the vital 
energies, which prevent them from recombining ; but that, as soon as 
they reach the secretory or excretory organs, they are thrown, as it were, 
beyond the sphere of those energies ; and their chemical affinities being 
brought into play, they recombine, and the substance is again percepti- 
ble, or can be detected, by tests in the excretions. A satisfactory reply 
to this hypothesis is, that such substances have actually been detected, in 
their entire state, in the blood ; and besides, no great safety to the 
economy could accrue from the decomposition in many cases, as the 
elements would be more injurious than the compound. The objections, 
indeed, to the view are signal. When substances can pass so readily 
into the vessels by imbibition, there is no necessity for invoking this 
operose process. There are, however, many medicinal agents, which 
require to be set free in the stomach before they can act on that organ. 
When certain vegetable substances are administered, especially in de- 
coction or infusion, the parts that are susceptible of the action, — the 
mucilage, extractive, &c, — are digested, whilst the medicinal component 
exerts its appropriate agency. Dr. Thomson thinks it is to this circum- 
stance, that we may ascribe the time, which elapses between the 
swallowing of certain medicines, and the period when their operation 
becomes apparent. " Thus," — he says, — " if half a drachm of powder 
of the root of ipecacuanha be swallowed, from fifteen to thirty minutes 
generally elapse before vomiting is produced, a circumstance, which we 
may fairly attribute to the envelopment of the emetina — the active con- 
stituent of the ipecacuanha — in the wax, gum, starch, and ligneous 
matter of the root ; it cannot exert its influence until extricated from these 
by the prcoess of digestion." But this is not a happy illustration of his 
position, inasmuch as the same length of time is required for the emetic 
operation, when ipecacuanha is given in forms that are devoid of these 
vegetable accompaniments, as in the vinum ipecacuanha of the pharma- 
copoeias, or in the various preparations of its active ingredient — emetia. 
Tartar emetic, too, is as long in inducing emesis, although it is well 
adapted for rapid absorption, or for instantaneous action on the nerves 
of the stomach. It will be seen hereafter, that a more satisfactory mode 



92 ACTION OF MEDICINES 

exists of accounting for the delay in the operation of both these useful 
drugs, when exhibited for the purpose of acting as emetics. 

Almost all writers on pharmacology affirm, that the acetate of potassa 
is decomposed in the stomach, — the acid being digested, whilst the 
alkali passes into the circulation, and is excreted by the kidneys. This, 
however, may admit of some question. The free acids, which are pre- 
sent in the stomach yi a state of health, are probably the chlorohydric, 
and the acetic ; and if the alkali of the acetate of potassa were set free 
during digestion, a part at least would be laid hold of by the chloro- 
hydric acid, and enter the circulation as chloride of potassium. The 
fact of the existence of those acids in the healthy stomach shows, that 
many substances, when taken into that organ, must undergo decompo- 
sition through their agency. In the case of the acetate of potassa, — 
the free chlorohydric acid, doubtless, lays hold of all the potassa, unless 
the quantity of the acetate be very large. In the dyspeptic, affected 
with unusual predominance of acid, any alkaline carbonate taken into 
the stomach excites effervescence, in the same manner as when added 
to the chlorohydric, or acetic acid out of the body. Nitrate of silver is 
a substance, which can rarely or never enter the circulation unchanged. 
It is possessed of caustic properties, and is often used to destroy fun- 
I gous granulations in wounds and ulcers. When applied in such cases, 
the nitrate is decomposed by the animal matter with which it is made to 
come in contact ; the oxide of silver remains on the surface, and by ex- 
■ posure to the air, becomes black.' If the salt, too, be taken internally, 
/ for any length of time, it is apt to produce a leaden hue of the surface. 
/ "Now it is evident," says Dr. Thomson, " that this effect could not 
J take place if the nitrate of silver were not taken into the circulation in 
an undecomposed state : for if the nitrate, were decomposed in the sto- 
mach, and converted into muriate of silver, this is an insoluble salt, 
and consequently not fitted to be taken up by the absorbents. But 
if we admit, that the nitrate of silver is taken into the circulation in its 
undecomposed state, we can readily explain the manner of its decompo- 
sition by the capillary vessels of the skin, and its deposition in the rete 
\ mucosum, in the state of an insoluble muriate, which would necessarily 
render any tinge, communicated by it to the skin, permanent." 

It is difficult to see how the nitrate can escape decomposition from the 
chlorohydric acid always existing in the healthy stomach, as well as 
from the chloride of sodium, which is present in the humours. It is 
probable, indeed, that, in the small quantity, in which it is administered 
internally, it never enters the circulation in the state of nitrate, but always 
in that of chloride ; which, — as Dr. Thomson properly remarks, — is 
insoluble ; but this is not an insuperable obstacle to its absorption. 
Calomel is equally insoluble, yet we want no proof, that the system is 
capable of being readily affected by it. The insoluble chloride of silver 
enters the sanguiferous system, is deposited in the corpus papillare and 
— under the influence of light — is converted from a white to a dark 
violet colour, — an effect which can be easily proved, by exposing 
chloride of silver to light, out of the body. Moreover, in recent expe- 
riments by Professor Oesterlen, in which powdered charcoal and other 
insoluble substances were administered to animals for five or six days 



THROUGH ABSORPTION. 93 

in succession, minute particles of those substances were distinctly 
detected in the blood of the mesenteric veins. 

Corrosive chloride of mercury or corrosive sublimate sometimes un- 
dergoes a conversion of great interest to the toxicologist. It may hap- 
pen that a person has been poisoned by the corrosive chloride, and yet 
there may be no evidence of the presence of anything in the intestinal 
canal, except the mild chloride or calomel. In such case, how are we 
to know,' whether the mild chloride be the result of the decomposition 
of the corrosive chloride, or whether the person may not have taken the 
mild chloride a short time prior to dissolution. When the corrosive 
chloride meets with albuminous matters, it is decomposed by them, and 
is converted into mild chloride ; but, in such case, the mild chloride is 
intimately united with them, and if the decomposition has been pro- 
duced by the animal matter of the coats of the intestines, it will be 
intimately united with them ; whilst, if the mild chloride has been taken 
prior to dissolution, it may be observed lying upon the mucous surface, 
and in no way amalgamated with it. 

Sometimes it would seem, after an article has passed into the circula- 
tion, that it is decomposed, either in the blood, or in some of the organs. 
If we force mercury through the skin, we can affect the salivary glands, 
and whilst the system is pervaded by it, a gold watch exhibits, by 
a white coating, that the mercury is exhaled by the cutaneous sur- 
face. In like manner, if blue pill, or calomel, be administered in ade- 
quate quantity internally, the watch will be equally coated by the mercury. 
We do not know the exact condition of the exhaled metal in these cases ; 
whether, in the case of the mercurial ointment and blue pill, it be still 
oxide, — in the state of calomel, still mild chloride ; — or whether, in all 
these instances, it be not decomposed, and given off in the form of mer- 
curial vapour. The fact, that metallic mercury has been detected in 
the bodies of such as have died under its influence, leads us to presume, 
that the metal may be reduced, and exhaled in the form of vapour, so 
as to occasion the coating in question. 

When substances enter the blood by absorption, if they can chemi- 
cally combine with any of the principles of that fluid, they probably do 
so ; but this is not accomplished so readily, as might have been pre- 
sumed, owing to the quantity of organic matter, which frequently inter- 
feres largely with inorganic affinities. Out of the body, we have full 
opportunity for witnessing the changes induced by the gases, and by 
various agents, on the blood prior to coagulation, and whilst still en- 
dowed with vitality. They are striking; and similar changes would, 
doubtless, be produced could the same agents be applied, in the same 
state of concentration, to the blood whilst circulating in the vessels. 
Numerous experiments have shown, that when certain substances have 
been given for a long time, the blood is rendered much thinner ; whilst 
directly contrary effects are observed to follow the use of others;— the 
coagulum being firmer, and the blood of a deep, or dark colour. As 
the pabulum, therefore, of the different nutritive processes is modified, 
we can readily comprehend, that the functions of secretion and nutrition 
may be importantly modified also. 

It is difficult, however, to arrive at any satisfactory inference in regard 



94 ACTION OF MEDICINES. 

to the action of medicines from their chemical qualities ; for whilst it 
often happens, that analogous substances — as the mineral acids— act 
alike ; the contrary is observed, as in the case of morphia and quinia. 
On the other hand, substances, that are very unlike— as castor oil and 
sulphur — have analogous action, when taken internally. In a series of 
experiments instituted by Professor Blake, of Saint Louis, he was led to 
infer, that, when introduced into the blood, the salts of the same base 
appear to exert the same effect on the animal economy ; and farther 
researches led him to the fancied discovery of a 'law,' that, when in- 
troduced into the blood, all isomorphous substances produce analogous 
effects, and give rise to the same reactions in the economy ; in other 
words, that the reactions, which take place between the elements of the 
living body and inorganic compounds, are not governed by the ordinary 
chemical properties of these substances, but depend on certain properties 
they possess connected with their isomorphous relations. 

One of the phenomena observed by him was the connexion be- 
tween the physiological action of substances and their isomorphous 
relations to the elements of the blood. He found, that those sub- 
stances, which exist in the blood or have isomorphous relations with 
its elements, have the least marked reactions. " The salts of palladium, 
platinum and baryta are those which prove fatal in the smallest doses ; 
and it is a curious fact, that under an isomorphous point of view, these 
three substances are those which have the least analogy with the ele- 
ments that enter into the formation of the animal solids and fluids. On 
the other hand, arsenic, which might have been supposed to be rapidly 
fatal, is so inert, when introduced into the blood, that it will not speedily 
produce death, unless, indeed, it is injected in quantities sufficient to 
directly coagulate the blood ;" — and he adds — that " it remains for future 
experiments to determine if this is owing to its being isomorphous with 
one of the elements of the fluids and solids, the phosphorous." 

The results arrived at by Dr. Blake are of deep interest ; and the 
line of direction he has pursued in his inquiries is certainly well worthy 
the attention of the physiologist. It may be added, that from certain 
experiments recently made by Mr. Nunneley on anaesthetic agents, he 
draws the conclusion, " that substances which are isomeric, or nearly so, 
but very dissimilar in physical and chemical properties, are also so in 
physiological ; as witness several of the pure hydrocarbons, which, 
though very similar in composition, are very different in properties." 

The difference in the rapidity with which the absorption of medicinal 
agents is accomplished is great. It is dependent upon the degree of 
distention of the vessels, and on the existence or absence of erethism in 
the part. If polyaemia or vascular fulness exists, absorption is tardily 
effected ; but if blood-letting be premised, the substance speedily passes 
through the coats of the blood-vessels, and enters the circulation. In 
some experiments by M. Magendie, in which water was injected into the 
vessels, so as to produce a state of artificial plethora, and a fluid was 
thrown into a serous cavity, it was found, that whilst the state of ple- 
thora existed, none of the fluid entered the circulation ; but when blood 
was drawn from a vein, the fluid in the serous cavity rapidly disappeared 
under the eye of the observer, by soaking through the coats of the ves- 



CLASSIFICATION OF MEDICINES. 95 

sels, and entering the circulatory current. Hence it is, that in those 
active effusions or transudations into serous cavities, which constitute 
dropsies, blood-letting may be a philosophical and energetic remedy. 

It has been said, that the activity of absorption is greatly dependent 
upon the existence or absence of erethism in a part. If the lining 
membrane of the intestinal canal be in a state of great irritation or in- 
flammation, the digestive, and other absorptions are no longer accom- 
plished. This is the case in malignant cholera, which usually consists 
of a peculiar excitation in the capillaries of the intestinal mucous mem- 
brane. Under this excitation, the watery portions of the blood are 
exhaled, until that fluid is, in many cases, left so thick, as to be unable 
to pass along the vessels ; and this, notwithstanding nutritive fluids 
may have been constantly and freely taken. It is, on this account also, 
that there is frequently so much difficulty in affecting gastro-enteritic 
patients with mercury. In the last stages of many of the bilious and 
typhoid forms of fever, the absorbent function of the intestines is almost 
annihilated, in consequence of the irritation in the mucous membrane 
of the digestive tube. 

Such are the chief modes in which medicinal agents exert their in- 
fluence on the human economy. 

I. Their action may be altogether direct or local. 
II. It may be general — through local influence. 

1. By means of the nerves. 

2. By absorption. 

2. CLASSIFICATION OF MEDICINES. 

The unbounded credulity, which at one time prevailed regarding the 
effects of drugs, and which so long disfigured the science of medicine, 
has greatly diminished, and we observe less and less of the old feeling 
of confidence in the adaptation of particular drugs to particular cases 
of disease. The practice has become more rational ; and efficacious 
agents are now mainly relied on. Still, many superfluities exist in the 
lists of the materia medica, which might, with much propriety, be dis- 
pensed with ; and time will accomplish this. The plan now is, — to 
discover the seat and nature of the diseased action, and to adapt a 
remedy, whose properties are known, to the exigency, — locally or 
generally, as the case may require. We have no agents, that are pos- 
sessed of specific properties, which are exerted with unvarying uniform- 
ity on disease. Their action .is modified by numerous circumstances. 
A cathartic may, in one case, excite emesis in place of catharsis ; and, 
in another, an emetic may excite catharsis rather than emesis ; whilst 
the words febrifuge, antispasmodic, &c, are mere terms to express the 
secondary result of some agent on the vital solid. It is in consequence 
of medicines possessing no specific — no uniform — influence, that so 
much skill and attention are required in the treatment of disease. At 
one time, it was supposed, that certain drugs are specifically adapted to 
combat certain morbid conditions, but the belief, except with the 
homoeopathists, is now exploded, and even mercury — the panacea of 



96 CLASSIFICATION OF MEDICINES. 

some — is denfed to possess any such power, and its action is more 
rationally accounted for. 

From what has been said, it will appear, that although we may be 
perfectly acquainted with the ordinary medicinal properties of a drug, 
and although these properties may be essentially the same, the agency, 
exerted by it, may be different according to the precise character of the 
disease, and according to the age, sex, temperament, &c, of the patient. 
Were these points determinate, we could always calculate with cer- 
tainty what would be the precise action of any medicinal agent. 

With regard to the parts of the frame on which medicines act, we 
may affirm, that they are capable of affecting every tissue and every 
function — directly or indirectly. Like other influences, which surround 
the body, and are perpetually impressing it in some mode or other, 
remedial agents can act upon the living organs so as to modify every 
function. Ultimately, however, they must all affect the same great 
vital property of contractility, irritability, incit ability, or excitability, 
whichsoever we may term it, which is seated in every living tissue. 
Under the influence of this vital property, kept in action by appropriate 
stimuli, all the functions are accomplished, and, when these stimuli are 
at a certain degree, accomplished in health ; but if, from any cause, the 
vital force becomes exalted or depressed below the healthy standard, 
disease results; and such disease may be one of increased or of dimin- 
ished action. Medicinal agents, which, in this way, exalt the vital 
activity of the body, are excitants ; and such as diminish it are seda- 
tives; and we may, consequently, with propriety, class all agents, that 
are useful, or that are not wholly inert, either as excitants , or as seda- 
tives. 

The subject of the classification of medicinal agents will, however, 
require a little farther consideration. 

The advantages of classification in science are obvious. The rela- 
tions of articles to each other are, in. this way, exhibited, so as to im- 
press the memory, and to facilitate the investigations of the student; 
but in no branch of science is it applicable under more difficulties than 
in Therapeutics, provided we are desirous of establishing such classifi- 
cation on the precise operation of medicinal agents; whilst nothing is 
more easy than to form a natural classification of them, founded simply 
on the three great kingdoms of nature to which they belong. Both 
these modes of classification, termed respectively the Therapeutical 
and the Natural Historical, have been detailed in all their varieties in 
works on Mareria Medica and Therapeutics. The classifications of 
medicinal agents, based on their operation, are numerous, and, at the 
same time, by no means satisfactory. Immense labour, and, of course, 
valuable time, have been spent upon the subject, without any rich 
fruit. It has been already said, that all remedial agents, which are 
possessed of activity, must belong to one of two classes, — stimulants or 
excitants, and sedatives: we must except, however, certain agents, 
whose effects are purely chemical or mechanical, or which are not em- 
ployed to effect any changes in the living tissue. Perhaps the best of 
all classifications would be one founded upon the agency exerted on 
the different tissues ; but this arrangement, in the present state of 



CLASSIFICATION OF MEDICINES. 



97 



science, is by no means easy; and, moreover, the action of medicines 
is so associated with certain terms, — as narcotics, tonics, sedatives, 
&c, employed to denote certain operations, which they are esteemed 
capable of producing, that, to abandon them, would be to throw obsta- 
cles in the path of the student, without the ultimate advantage accruing 
to him, of possessing a better knowledge of the modus operandi of 
medicines, than when a classification, somewhat resembling those 
usually embraced, is adopted. The classification of M. Barbier is 
founded upon the tissues affected, but it is extremely incomplete, and 
unsatisfactory; and, in consequence of the impracticability experienced 
by him in grouping the various agents under appropriate heads, his 
last unmeaning division is, of course, a large one. 



BARBIER S CLASSIFICATION. 

("Which strengthen the tissue of organs, 

Which stimulate the tissue of organs, 

Which relax the tissue of organs, 

Which moderate too great activity of organs, 

Which diminish cerebral life, 

Which irritate the inner surface of the intes- 

Medicistes -^ tines, 

Which irritate the gastro-duodenal surface' 

especially, 

Which disturb the natural movements of the 

intestines, ..... 
Whose modus operandi is not determined, or" 

which cannot be included in the prece- . 
^ ding classes, 



Tonics. 

Excitants. 

Diffusibles. 

Emollients. 

Temperants. 

Narcotics. 

7. Purgatives. 

8. Emetics. 

9. Laxatives. 

10. Incertse sedis. 



One of the most modern classifications is that of Dr. A. T. Thom- 
son, founded upon the classifications of Dr. Thomas Young, and Dr. 
Murray. It, also, is liable to the objections, which must apply to all 
attempts to reduce the multitude of medicinal agents to anything like 
a scientific arrangament, as well as to others, which appertain to it 
exclusively. 

It is as follows: 

I. VITAL AGENTS. 
a. Influencing the body generally : 

a. — By operating directly upon the nervous system. 
* Increasing action, ....... 



** Diminishing action, 
b. — On the Muscular and Sanguiferous systems : 

c. — On the Secerning system : 



Vol. I.— 7 



Excitants. 

D • •/ C Sedatives. 

Primarily, ■? D c . 

a £ Kefngerants. 

o j •/ ^ Narcotics. 
secondarily, < . t . .. 

° (_ Antispasmodics. 

Tonics. 
Astringents. 

Errhines. 

Sialagogues. 

Expectorants. 

Emetics. 

Cathartics. 

Diuretics. 

Emmenagogues. 

Diaphoretics. 



98 CLASSIFICATION OF MEDICINES. 

b. — Influencing the body solely by their action on the part to 

which they are applied : _ , 

rr Epispastics. 

a. Rubefacients. 

b. Vesicants. 

c. Actual cauter ants. 

II. CHEMICAL AGENTS. 
a.— Influencing the state of the body, or its contents, by their 
chemical properties : 

* Acting on the surface, Escharotics. 

a. Potential cauterants. 
f Antacids. 
. . J Antalkalies. 

** On the contents of cavities, S Antiseptics 

l^ Antilithics. 



III. MECHANICAL AGENTS. 



Demulcents. 
Diluents. 



To the three great divisions of Dr. Thomson no objection need be 
urged ; but when the different subdivisions, and the ascribed modus 
operandi of many of the classes are considered, much room is found for 
difference of sentiment. It may be observed by anticipation, that there 
is no adequate ground for placing Excitants amongst those agents that 
operate directly on the nervous system ; and Tonics amongst those that 
act on the muscular and sanguiferous systems; nor is it readily seen, 
how Epispastics can be regarded as the only agents, that influence the 
body solely by their action on the part to which they are applied. The 
class of Anthelmintics, which could not have fallen conveniently under 
any of Dr. Thomson's subdivisions — with the views, which he probably 
entertained of the mode, in which their therapeutical agency is exerted — 
has been wholly omitted ; and. although anthelmintic virtues are assigned 
to the ordinary medicinal agents, that are conceived to possess such 
virtues, when these agents are referred to under other heads,-rit is 
singular, that the class is neither mentioned in the table, nor in the 
body of the work. It seems to have altogether escaped Dr. Thomson's 
attention. 

In the last edition of his valuable '' Encyclopaedia of Materia Medica," 
for so the work has been appropriately termed by him, Dr. Pereira has 
attempted — to employ his own diffident expression — anew physiological 
classification of the articles composing the Materia Medica, but has, at 
the same time, stated his conviction of the insuperable difficulties in 
the way of a satisfactory and unobjectionable arrangement of medicines 
on a physiological basis. His classification — partly founded on some of 
the modern German arrangements — has the merit of bringing together 
systematically the most important agents, although well founded doubts 
may exist as to the propriety of positions, which he has assigned to indivi- 
dual articles ; and still more as to the necessity of many of the subordi- 
nate heads introduced by him. 

f Mechanical antidotes. 
" Class I. Topical remedies acting mechanically. J Mechan ical purgatives and anthel- 

^Dentifrices. 



CLASSIFICATION OF MEDICINES. 



99 



Class II. Topical remedies acting chemically. -^ 

Class III. Topical remedies acting dynamically. 
'a. Physically. 



Class. IV. Haematics 
or remedies acting on the-^ b. Chemically, 
blood. 



\jc. Dynamically. 

Class V. Pneumatics or remedies acting on the 
organs of respiration. 



rCaustics. 
j Astringents. 

Chemical Antidotes. 
^Disinfectants. 
c Acrids. 
£ Emollients. 
C Diluents. 
t Inspissants. 
'"Spanaemics or impoverishers of the 
blood. 

a. Thirst quenching and refrigerant. 

b. Resolvents or liquefacients. 

1. Alkalines. 

2. Salines. 

3. Iodics and bromics. 

4. Sulphurosa. 

5. Mercurialia et antimonialia. 
c Antispasmodic. 

d. Plumbeous or saturnine. 
^Haematinics or enrichers of the blood. 



< 



"Cerebro-spinals. 



Class VI. Neurotics 
or remedies acting on the-^ 
nervous system. 



J2. Ganglionics. 



Class VII. Cceliacs or remedies acting on the 
digestive organs. 



("Affecting the muscles of respiration. 
| Affecting the ae'rian membrane. 
^ Diminishing the want of breath. 
| Influencing the calorific functions. 
^Refrigerants. 
fl. Affecting the mind ; phrenics. 

2. Affecting sensibility ; aesthetics. 

a. Strengthening it ; hyperaesthe- 
tics. 

b. Lowering it ; anaesthetics. 

3. Affecting voluntary and reflex spi- 
nal movements ; cinetics. 

a. Affecting the tonicity of mus- 
cles. 
aa. Augmenting it ; tonics. 

-^ bb. Depressing it ; relaxants. 

b. Affecting the irritability of mus- 
cles. 

aa. Augmenting it; spastica. 
bb- Diminishing it ; paralytica. 

c Affecting volition. 
d. Affecting the reflex spinal func- 
tions. 
Affecting sleep ; hypnics. 

a. Causing it ; hypnotics. 

L b. Preventing it ; agrypnotics. 
fl. Affecting the heart and arteries, 
a* Exciting them ; stimulants. 

aa. Ethereo-oily vegetables. 

bb. Resinous. 

cc. Ammoniacal and empyreu- 
■<( matic. 

dd. Animal excretions. 

ee. Phosphorus. 

ff. Spirituous and etherial. 

b. Depressing them ; sedantia. 
J2. Affecting the alimentary canal. 
fl. Enterics; anthelmintics. 
! 2. Hepatics. 



< 



3. Splenics. 



V.4. Sialics and pancreatics. 



100 CLASSIFICATION OF MEDICINES. 

fl. Errhines. 

2. Expectorants. 

3. Emetics, 
f 1. Augmenting secre- J 4. Cathartics. 

tion. ) 6« Diaphoretics. 

Class VIII. Eccritics, | I 6. Sialagogues. 

or remedies acting on the<( I 7. Cholagogues. 

excernent system. U*« Diuretics. 

2. Diminishing secretion. 
^.3. Altering the quality of the secretions; lithics. 
r* 1. Affecting the organs, 

Class IX. Genetics or j anaphtdSacs, 

remedies acting on the <^ 2 Affecti the uterus> 
sexual organs. emmenagogues, 

\^_ ecbolics." 

The divisions and subdivisions of this table are sufficiently ample ; 
and Dr. Pereira is enabled — which is of great moment — to introduce 
every potent article into some one of them ; although it may be ques- 
tioned, whether the position has been selected in all cases correctly. 
Under " resolvent or liquefacient spanEemics," for example, — the liquefa- 
cientia (verflussigende Mittel) of Plagge and other German the- 
rapeutists, — he places alkalines, salines, iodics and bromics, sulphurous 
agents, mercurials, and antimonials. Arsenic is not there ; nor are 
there other articles which modify nutrition, and were, in older periods, 
enumerated with many others as " alteratives !" Arsenic appears under 
the sub-order spancemica antispasmodica along with sulphate of copper, 
and ammoniated copper, nitrate of silver, trisnitrate of bismuth, oxide 
of zinc, and sulphate of zinc. Under the head of arsenious acid, how- 
ever, he remarks: — " on the whole it is impossible, I conceive, in the 
present state of knowledge, to designate the medicinal effect of arsenic 
by any term, which shall briefly but characteristically declare its physio- 
logical properties. The terms, tonic and antispasmodic are quite insuffi- 
cient for the purpose ; nor am I satisfied with the designation antispas- 
modic spancemic before given to it." 

The evidence derived from our knowledge of the modus operandi of 
the different agents classed under the resolvent or liquefacient, and the 
antispasmodic spanEemics appears to be insufficient to establish such 
sub-orders. All that we seem to know of the remedial agency of the 
former is, that they modify nutrition, in all probability through some 
change impressed by them on the blood, and in this manner remove the 
different forms of dyscrasy in which they have been found efficacious ; 
but that they do this as " spanaemics" or " impoverishes of the blood," or 
as " liquefacients" of the morbid formations, appears to be wanting in 
confirmation, and even in probability. 

In regard to " antispasmodic spanaemics," the more the action of re- 
puted antispasmodics is investigated, the more clear is it, that we are not 
possessed of any agents that can be considered to be endowed with posi- 
tive antispasmodic virtues. Spasm — as will be shown hereafter is prima- 
rily a nervous phenomenon, which may be the result of a sthenic or an 
asthenic condition ; so that remedies, possessed of antithetic effects as 
vital agents, may be entitled, according to the condition of the system, 
to the epithet " antispasmodic." 



CLASSIFICATION OF MEDICINES. 



101 



To the following classifications of the author, objections equally apply. 
He has already said, that it is impracticable to form any, -which can be 
altogether unobjectionable. It has been more than once remarked, that 
all agents, capable of affecting the vital tissue so as to modify its func- 
tions effectively, may be classed under the head of excitants, or of seda- 
tives. But, in addition to these — what may be called — " vital agents ," 
there are some other classes of medicines, which, in consequence of 
their effect being almost purely chemical, without modifying the condi- 
tion of the living tissue, may be appropriately designated chemical 
agents; and, again, there is one other class equally without direct in- 
fluence on the vital manifestations, and acting simply or chiefly on the 
mass of humours — which may be properly ranked under the denomina- 
tion of mechanical agents. This is probably as simple a classification as 
can be made, and one altogether intelligible to the student. It does 
not involve questions connected with the intimate modus operandi, 
which must necessarily engage attention in considering the different 
classes, whilst it embraces some classes not admitted into the arrange- 
ment of Dr. Thomson, and which comprise some of our most useful 
medicinal agents. The class of Anthelmintics — in the sense of — ■" me- 
dicines, which prevent the generation of entozoa within the body," is 
placed next to the class of tonics ; because the predisponent cause of their 
unusual multiplication is a want of tone of the system generally, and of the 
stomach in particular ; and if we confine our attention to the destruction 
of these parasites by true anthelmintics, or, in other words, by agents 
directly destructive to entozoic life, we do but little, — the most import- 
ant step being to remove the predisposition to fresh generation. As, in 
the case of intermittent fever, the main object of the practitioner is less 
directed to the condition of the patient during the paroxysms, than to 
the prevention of their recurrence. 

CLASSIFICATION OF THERAPEUTICAL AGENTS. 



r 



I. Vital 
Agents. 



r 



Excitants. 



increasing action 
generally, or locally, *{ 
or both. 



I 



" Excitants proper. 

Tonics. 

Anthelmintics. 

Astringents. 

Emetics. 

Cathartics. 

Emmenagogues. 

Abortives. 

Diaphoretics. 

Errhines. 

Sialagogues. 

Diuretics. 

Expectorants. 

Sorbefacients. 

Revellents. 
L Antispasmodics. 



Sedatives. 



r 



i 



, diminishing action 
} directly or indirectly. 
I 



II. Chemical Agents. ....... -^ 



f Sedatives proper. 
} Narcotics. 
\ Refrigerants. 
V_ Nauseants. 

f Antacids. 

1 Antalkalies. 



Antilithics. 
I Disinfectants. 



102 CLASSIFICATION OF MEDICINES. 
HI. Mechanical Agents £ 



Demulcents. 
Diluents. 



This was the classification adopted by the author in the first edition 
of his " General Therapeutics;" but he has found it convenient to 
embrace one that harmonizes more with the arrangement adopted in 
his "Practice of Medicine." The different classes of therapeutical 
agents, and the agents themselves, will be investigated in the following 
order : 

C Emetics. 
1. Agents that affect prominently the alimentary canal or its con- _> Cathartics. 



tents, 

2. Agents that affect prominently the respiratory organs, 

3. Agents that affect prominently the glandular organs, 

4. Agents that affect prominently the nervous system, . 

5. Agents that affect prominently the organs of reproduction, 

6. Agents that affect various organs, 

7. Agents whose action is prominently chemical, . 

8. Agents whose action is prominently mechanical, 



_ Anthelmintics. 

Expectorants. 

C Errhines. 
J Sialagogues. 

t Diuretics. 
Antilithics. 
Diaphoretics. 

C Narcotics. 

< Tetanies. 

(_ Antispasmodics. 

C Emmenagogues. 
(_ Parturifacients. 



f Excitants. 

Tonics. 

Astringents. 
•^ Sedatives. 

Refrigerants. 

Revellents. 
,_ Eutrophics. 

Antacids. 

Antalkalies. 

Disinfectants. 



Demulcents. 
Diluents. 



EMETICS. 103 



SECTION I. 

AGENTS THAT AFFECT PROMINENTLY THE ALIMENTARY CANAL OR ITS CON- 
TENTS. 



I. EMET'ICS. 

Synon. Vomiioria. 

Definition of Emetics — Nauseants — Their modus operandi — Therapeutical application 
Physiology of vomiting — Modus operandi of emetics — Effects on the stomach, and gen- 
eral system — Evils of their too frequent employment — Therapeutical application — Special 
emetics. 

Emetics have been defined, "'agents, which by the excitant effect 
they produce upon the stomach, give occasion to vomiting;" but this 
definition is meagre and unsatisfactory. That of Dr. Paris is to be pre- 
ferred : — " Substances which excite vomiting, independently of any 
effect arising from the stimulus of quantity, or of that occasioned by 
any nauseous taste or flavour." 

The physiology of vomiting has, of late years more especially, engaged 
the attention of some of the most accurate anatomists, and physiolo- 
gists. At onetime, it was universally conceived, that the stomach is 
the main — indeed, the sole — agent ; whilst, at an after period, the oppo- 
site view was maintained, and the stomach was denied any agency 
whatever in the result. The intimate consideration of this topic of 
physiology has been gone into in another work ; and it is not neces- 
sary to repeat it here. It may be observed, however, that the former 
of the theories referred to, which prevailed of old, is full of error, and 
ought to be discarded ; and that, as often happens, when exclusive and 
antagonistic views are maintained, the truth probably lies between them, 
or may consist of a combination of both. From a careful examination of 
what has been said on both sides of the question, it appears, that we 
are justified in inferring, that the stomach, of all the organs concerned, 
is the one whose action is least energetic and indispensable ; that the 
pressure, exerted on its parietes by the diaphragm, and abdominal 
muscles, is the most powerful cause ; as, it is found, that the more or 
less complete paralysis of the diaphragm, or the destruction of the ab- 
dominal muscles, renders vomiting much more feeble, and more slow 
in manifesting itself. 

When an emetic has been taken in a sufficient dose, a train of phe- 
nomena makes its appearance contrasting greatly with those that follow. 
An indescribable sensation is first of all experienced, which is chiefly 
referred to the region of the stomach, and consists of a feeling of 
anxiety, and of circumgyration, which extends also to the head ; a co- 
pious flow of saliva and of sweat takes place, with paleness of the sur- 
face, and, indeed, every sign of diminished nervous and vascular ac- 
tion. This state of " nausea," as it is termed, is manifestly one of 
debility, or of diminution of the vital powers ; and, when it has con- 
tinued for any length of time, is usually succeeded by a very different 



1 04 EMETICS. 

condition of the functions; the diaphragm and abdominal muscles are 
thrown into violent contraction ; an inverted action of the muscular 
coat of the stomach is produced ; and, under these combined actions, 
the contents of the stomach are ejected. During this state of excited 
action, the pulse assumes fresh vigour : the skin becomes florid, espe- 
cially that of the face ;• a copious, warm perspiration takes the place of 
the cold, clammy sweat of nausea, and all is energy where depression 
previously prevailed. 

It is obvious, then, that the therapeutical effects of substances, capa- 
ble of exciting emesis, must vary according as they are administered to 
keep up nausea, or given in doses sufficient to induce emesis ; and, 
again, that emetics may differ amongst themselves according as their 
operation is preceded or not by more or less nausea. 

Where the nauseant operation is alone induced, the effects of the 
remedy are so different as to demand a separate consideration. 

I. NAUSEANTS. 

The state of nausea being one of reduced action, it can be readily 
understood, that a sedative agency, thus induced, and kept up for a 
sufficient length of time, may succeed in subduing inflammation, and 
the morbid exaltation of organic actions which constitutes ordinary 
fever. These results can be accomplished by nauseating remedies 
properly administered. 

From the effects which nauseants are capable of inducing, their 
therapeutical application will be sufficiently obvious ; and, accordingly, 
but little difficulty is experienced by the practitioner in laying down 
his indications, or in carrying them into effect, by some one or more of 
the numerous nauseants, which are contained in the catalogues of the 
materia medica. 

With regard to the condition of the functions under the influence of 
a nauseant, — when pushed to the extent of inducing marked nausea, — 
there can be no difference of opinion; but it has been a question, 
whether, if these same agents be given so as to fall short of inducing 
nausea, or any sensible evidences of their action,— in alterative doses, 
in other words, — they may not modify the functions in the same manner 
as full nauseants, but to a less degree. 

A great deal may be said in favour of the affirmative view of this 
question, but it is one obviously not easy of demonstration. Were we, 
indeed, to deny the position altogether, it would be difficult to account 
satisfactorily for the operation of antimonials, or of many other reputed 
diaphoretics in small doses, which are emetic in larger. 

All admit, that when the tartrate of antimony and potassa is given so 
as to produce nausea, it is a decided sedative and diaphoretic, — dia- 
phoretic because sedative. The state of nausea being, as already 
remarked, one of diminished action, — the exalted vital manifestations, 
constituting fever, are reduced by it ; and diaphoresis, which had been 
checked by the febrile irritation, is restored. In this case, the antimo- 
nial, — like every diaphoretic, — is an indirect agent only. But if it be 
given in doses somewhat smaller than are requisite to induce nausea 



NAUSEANTS. 105 

it can be conceived, that an action of sedation may be exerted, although, 
it must be confessed, that we have no sensible evidence of such an 
effect except the result; and it must be equally confessed, that, in our 
uncertainty, we ought scarcely to place that confidence in those agents, 
which is occasionally reposed in them by practitioners. Fortunately, 
however, — as remarked under another section, in regard to antimonials 
especially, — this very confidence is, at times, followed by negatively 
beneficial results. It prevents the partisans of the perturbating treat- 
ment of fever, by means of violent and repeated cathartics, from causing 
as much irritation as they might otherwise do ; and gives the patient a 
little of that quietude and absence from disturbance, which is so impor- 
tant in the management of all febrile cases, and especially of such as are 
accompanied by erethism in the mucous membrane of the intestines. 

Therapeutical application of Nauseants. 

Internal inflammation. — In all internal inflammations, nauseants are 
obviously proper, as well as in every kind of active hemorrhage ; — 
whenever, indeed, it is desirable to diminish the force and velocity of 
the circulatory movements. In such cases, they are amongst our most 
valuable therapeutical means, and, if the system can be kept, for any 
length of time, sufficiently under their influence, the local hyperasmia 
will often yield, after it has resisted other agencies. In a case of peri- 
carditis, which fell under the author's care, and which threatened fatal 
results, the acetate of morphia was administered in a full sedative dose ; — 
this salt being preferred to opium* in consequence of the latter disagree- 
ing in the particular case : the nausea, caused by it, was intense ; but 
the symptoms were so much ameliorated, that the dose was repeated : 
in this way, the nausea was kept up for forty-eight hours, and, during 
the condition of sedation, the inflammatory signs disappeared, and the 
patient ,doubtless owed her safety mainly to the nauseant agency. 

Constipation. — In constipation, a union of nauseants with cathartics 
becomes occasionally advisable, and at times effectual, after cathartics 
alone have been employed unsuccessfully. If the constipation be de- 
pendent upon any irritated condition of the exhalants of the canal, the 
use of debilitants, — such as those now under consideration, — reduces 
the erethism, and facilitates the operation of the purgative. Whenever, 
too, it is desired to break in upon a morbid chain, and especially in 
the neuroses, nauseants may be beneficially administered : but, in these 
cases, the revulsion, induced by a nauseating emetic, is generally pre- 
ferred, in consequence of the more powerful impression which it makes 
on the nervous system. This subject will, however, be fully canvassed, 
under the heads of Emetics, and Revellents. The practitioner has, 
in all cases, to reflect, whether the state of the organic actions be such 
as to require the debilitant agency, which nauseants are capable of 
exerting ; and it is not generally difficult to arrive at a correct conclu- 
sion. Perhaps, in all cases, the tartrate of antimony and potassa is 
capable of fulfilling every desire of the physician ; but, occasionally, 
other articles are selected : — ipecacuanha by some ; squill — particularly 



106 EMETICS. 

when the affection is seated in the air passages — by others ; but there is 
not sufficient reason for the belief, that any nauseant is preferable to 
the tartrate of antimony and potassa ; and, moreover, — being devoid of 
any stimulating property, — it can be administered in many cases, in 
which the exciting emetics would be obviously improper. 

Surgical cases. — With similar views to those that impress the physi- 
cian, the surgeon has recourse to nauseants. Whenever it is desirable 
to depress the energies of the system, and to induce relaxation of con- 
stricted parts, they are advantageously employed. In strangulated her- 
nia, tobacco smoke, or tobacco infusion is thrown into the rectum ; but, 
as will be shown hereafter, the use of tobacco, even in this form, is not 
devoid of danger ; and, perhaps, there is no relaxant effect produced 
by it, which might not be equally produced by the nauseants above 
mentioned. 

When a luxated limb has to be reduced, the force of contraction of 
the muscles is diminished during the existence of nausea ,; and if the 
surgeon, at the time, employs his manoeuvres dexterously, he may suc- 
ceed in effecting the reduction. 

Obstetrical cases. — To the obstetrical practitioner nauseants are not 
less useful. When tartar emetic is given so as to impress the system, 
it removes rigidity of the os uteri ; and in violent or irritable labour the 
inordinate activity of the uterus is allayed by it, whilst the dilatation of 
the mouth of the organ is facilitated. Dr. Kennedy, of Dublin, has 
drawn the attention of practitioners to these cases, as well as to the 
value of nauseants in puerperal convulsions, in obstructed and inflamed 
mammae, and in puerperal mania. 

But it is needless to attempt to point out every affection in which 
nauseants may be employed with advantage. By bearing in mind the 
sedative influence they are capable of exerting, the practitioner can meet 
with little difficulty in deciding upon the cases in which their exhibition 
may be noxious or salutary. 

II. EMETICS. 

In order that an emetic shall produce its effect upon the stomach, it 
must affect the cerebro-spinal axis. Should it irritate the nerves of the 
stomach, that irritation must be appreciated by the nervous centres, and 
a reflex action be exerted upon the stomach, before it can discharge its 
contents. It is not necessary, however, that the impression should be 
first made on the gastric nerves. Certain sources of irritation, seated 
elsewhere, may impress the nervous centres by their irradiations, and 
produce the same effect. 

Various circumstances affecting the nerves of the stomach may excite 
vomiting ; — for example, the administration of substances belonging to 
the class of emetics; over-distention of the organ ; offensive character 
of food ; morbid secretions from the supra-diaphragmatic portion of the 
alimentary canal, or from the stomach itself; reflux of bile into the 
stomach, &c, &c. In these cases, the impression is made upon the 
nerves of the stomach ; thence it passes to the nervous centres which 



GENERAL EFFECTS. 107 

appreciate the sensation, and call upon the different organs, concerned 
in vomiting, to execute their functions. 

But, numerous cases present themselves, in which the impression is 
first received on other parts than the stomach, and where it equally pro- 
ceeds to the nervous centres, which then call for the action of the appro- 
priate organs. Thus, the stomach sympathizes with an organ that has 
been long suffering under chronic irritation : there is, indeed, scarcely 
an organ in the body, which, when affected with protracted suffering, 
does not disorder the functions of the stomach, and induce vomiting. 
The irritation of the uvula, when elongated, and the presence of tena- 
cious phlegm in the posterior nares, bring on a kind of " gagging ," 
which is occasionally followed by full vomiting. We have examples, 
also, in which the nervous impression is even more remotely connected 
with the effects than in those selected. The sight of a disgusting object 
will "turn the stomach" of many. The same may be said of nauseous 
smells, and flavours ; of riding, sailing — especially at sea ; swinging, &c. 
In all these cases, the impression is made on the nerves, — the great 
nervous centres being primarily or secondarily affected. Did it indeed 
admit of the slightest question, that the nervous centres must always be 
implicated in the act of vomiting, the circumstance, that if their impressi- 
bility be blunted by narcotics, it is excessively difficult to excite vomit- 
ing, — a fact which has to be borne in mind when the therapeutist is 
called upon to act in cases, where narcotics have been taken as poison, 
— would tend to establish the affirmative. 

In many cases, the effect of an emetic agency — although apparently 
produced with inconceivable rapidity — must be the result of a very 
complex and reflex operation. When, for instance, pain in a distant 
organ sickens, the afferent nerves must convey the impression from the 
affected organ to the vesicular matter in the centre of the spinal mar- 
rows—thence a reflex action must take place to every part of the sur- 
face of relation, and the gastric nerves be specially impressed, and call 
on the nervous centres, to send the nervous influx to the organs par- 
ticularly concerned in the act of vomiting. 

When vomiting has continued for some time, accompanied by violent 
retching, more or less bile is always evacuated, — the inverted action 
of the stomach being extended to the duodenum ; and the irritation, 
produced in the alimentary canal, being propagated along the biliary 
ducts to the liver ; so that the secretion from it becomes augmented. It 
is a common belief, that where bile is discharged during vomiting, in- 
duced in this or in any other way,, it is a proof, that the person is — 
what is termed — "bilious ;" but, for the reasons just assigned, it may 
be no more than an evidence that emesis has taken place with retch- 
ing. In violent mischief affecting the intestinal canal — as in cases of 
colica ileus — the inverted action extends even as low down as the large 
intestine ; the faeces are made to clear the ileo-csecal valve, and are dis- 
charged by the mouth, giving rise to the alarming phenomenon of ster- 
coraceous vomiting ; but this never occurs from the administration of 
any emetic. It is always an index of serious lesion or obstruction of the 
intestinal tube. 

The action of an emetic is local as regards the stomach ; but it ex- 
tends to almost every organ of the body. It has been already said, that 



108 EMETICS. 

its effect is that of an excitant to the nervous and sanguiferous systems, 
causing the blood to circulate more freely through the capillary vessels ; 
and, in this way, trifling obstructions may be removed ; but if the 
obstruction amounts to hypersemia, and especially if this latter condition 
exists to any great extent, it may be increased by it. In all the varieties 
of hyperemia, that characterize local inflammation, there is, as the 
author has attempted to show, an over-distended and atonic condition 
of the extreme vessels, induced by the blood having been sent into 
them, under some source of irritation, in undue quantity. This over- 
distended state of capillaries gives occasion to remora of blood in them, 
and excites the vessels, communicating with them, to inordinate action ; 
and it is obvious, that if, in such a state, a remedial agent be adminis- 
tered, whose effect is to hurry the circulatory fluid towards the affected 
parts, the hypersemia may be augmented. Accordingly, it might be sup- 
posed, that emetics would act injuriously, when any of the internal 
organs are labouring under inflammation. This would seem, indeed, to 
be a general principle of therapeutics, and to be especially applicable 
to inflammation of those viscera, which are more particularly affected 
in a mechanical manner during the operation of vomiting ; but excep- 
tions can be readily imagined ; or rather, there may be modifying cir- 
cumstances, which may be urged against its universality. In active 
inflammation, for example, there is more or less concentration of the 
vital energy towards the inflamed paft ; but the effect of the operation 
of an emetic is to propel the blood towards every organ of the body, 
and thus to equalize the circulation. 

There is, too, another effect of emetics, which enables us to produce 
positively beneficial results in internal inflammations of organs not im- 
mediately concerned in the act of vomiting; this is the revulsive, — one 
of the most important, indeed, of therapeutical agencies. The stomach, 
and the organs more immediately concerned, are, in this way, made the 
centre of an artificial fluxion, which detracts from that existing in some 
other portion of the organism. Under this joint equalizing and revulsive 
agency, emetics are beneficially employed in certain inflammatory affec- 
tions, notwithstanding their tendency to add to the hypersemic condi- 
tion ; — the good, effected by the equalization and revulsion, largely 
preponderating over the injurious tendency in question. 

During the efforts of vomiting, the abdominal viscera are compressed 
by the contraction of the diaphragm and abdominal muscles; hence the 
different secretions, that take place from them, are augmented ; and a 
tendency to displacement results, so that hernial protrusions may be pro- 
duced, — or increased, if already existing. The different procidentia?, 
too, of the pelvic viscera are injuriously affected by the pressure, and if 
the female be impregnated, abortion may be occasioned : indeed, there 
are certain obstetrical physiologists, who think, that the extrusion of the 
child, in parturition, is altogether accomplished by the contraction of 
the abdominal muscles, — a position, which would not appear to be tena- 
ble. By placing the hand on the abdomen during one of the violent 
throes of labour, that viscus can be felt contracting energetically ; can 
be seen, indeed, to do so, where, — as in France, — the clothes are thrown 
up at the termination of labour, in order that the eleves may have an 
opportunity of inspecting the phenomena connected with man's ingress 



GENERAL EFFECTS. 109 

into the world. Were it otherwise, there would seem to be no necessity 
for the development of muscular fibres, which is found to take place as 
the uterus becomes distended in utero-gestation. 

In the efforts of vomiting, the circulation, as above remarked, be- 
comes hurried, so that evil might result in those, who are labouring 
under aneurismal or other serious lesions of the heart and arteries; and 
instances are on record, where the vessels have aiven way during retch- 
ing. The circulation through the lungs, as in every other part of the 
frame, becomes augmented in velocity ; the secretions from the bronchial 
tubes are rendered more copious, and hence an emetic becomes an 
1 expectorant* — an agent whose modus operandi will be inquired into 
hereafter. This effect is not facilitated solely in the manner described. 
The succussion communicated to the lungs, by the repeated contraction 
and relaxation of the diaphragm during vomiting, not only increases the 
secretion, but dislodges it when secreted, so that it becomes loose and 
more readily expelled by coughing. Hence it happens, that a hard, and 
dry cough is converted into one that is loose, and free. 

In the accelerated action of the larger organs of circulation produced 
by vomiting the capillary vessels participate ; and a copious and warm 
perspiration usually supervenes, contrasting singularly with the cold, 
clammy perspiration of nausea. Hence, emetics become ' diaphoretics.* 

As to their effect on the stomach, they may simply evacuate its con- 
tents, which may consist of food taken in, with the secretions from 
the supra-diaphragmatic portion of the tube as well as from the organ 
itself. At times, these last secretions are morbid, and unless they are 
removed, they may become the source of irritation. This is especially 
the case in diseases accompanied with great erethism of the dermoid 
tissue. Whenever the cutaneous surface is extensively excited, — as 
indicated by great heat or by efflorescence, — the mucous membrane 
lining the stomach is apt to participate in the irritation, so that secre- 
tions of a morbid character take place from it : these secretions can 
be readily removed by the action of a gentle emetic. It is easy to 
see, however, that, under the stimulation produced by emetics of 
powerful action, the lining membrane of the stomach must be more 
or less excited, and hence, a copious secretion of the mucous fluid takes 
place ; mucus is observed to be mixed with the rejected matters ; and, 
for the reasons already assigned, bile is generally present. But, if sub- 
stances too irritating, or too violent in their action, be administered, the 
membrane may become inflamed, and true gastritis or gastro-enteritis 
result. It has been properly remarked by M. Broussais, that the specific 
character of emetics and purgatives is merely stimulation, which rnay 
terminate, if the dose be very large, in inflammation and ulceration of 
the digestive mucous membrane. The same author has well said, too, 
that the long-continued employment of stimulants — as emetics — greatly 
exalts the sensibility of the stomach, rendering the treatment protracted 
and difficult, and laying the foundation for repeated relapses. 

Full vomiting, accompanied with much retching, or nervous concen- 
tration on the stomach, promotes both exhalation and absorption. The 
cutaneous transpiration is augmented, as it is in the precursory state of 
nausea; but the perspiration, induced at these two periods, is essen- 



110 EMETICS. 

tially different. In the former case, it is the healthy, energetic action of 
vessels, similar to that which takes place in rude health under the agency 
of exercise or external warmth : in the latter, the whole system is labour- 
ing under temporary debility ; and the cold clammy exudation sufficiently 
exhibits the diminished activity of the vital forces. 

Absorption is affected- by the same class of agents ; but, with regard 
to the precise mode irwwhich the result is produced, therapeutists differ. 
It cannot be because m the augmented secretion which takes place from 
the lining membrane of the stomach, for that is to a trifling amount;— 
so trifling, indeed, that it could not be expected from this cause, that 
any unusual demand would be made upon the absorbents of any part of 
the system. We can account for absorption being more energetically 
exerted in cases of dropsy after the administration of agents, as hydra- 
gogue cathartics, which occasion a greater separation of the watery parts 
of the blood, or after blood has been taken from the vessels ; because 
here the quantity of circulating fluid being diminished a more ready 
imbibition of the fluid of dropsy is effected ; but this explanation does 
not well apply to the operation of emetics. It will be shown hereafter, 
that the nervous system is largely concerned in the operation of certain 
agents that modify the function of nutrition ; and this is probably the 
case in vomiting. The powerful nervous concentration on the stomach, 
and the different organs concerned in vomiting, interferes probably with 
the functions of nutrition and secretion in other parts of the organism, 
so that less fluid may be exhaled, whilst that, which has already been 
deposited, passes through the coats of the blood-vessels by imbibition, 
and gains the fluid of the circulation. This modification of nutrition is 
exemplified in the disappearance of morbid growths under the touch of 
royalty, the wand of the magician, and the incantations of the impostor. 

From what has been said, it will be readily inferred, that emetics, like 
local stimulants in general, are valuable revellents ; although, owing to 
the powerful effects they produce on the whole vascular and nervous 
system, they may not be susceptible of such useful application as cathar- 
tics, whose operation is more circumscribed. In head affections, for 
example, w 7 hilst cathartics are of great advantage by deriving from the 
encephalon, and occasioning a salutary excitation in the lining mem- 
brane of the bowels, emetics may be of doubtful propriety, owing to the 
violence of their operation forcing the blood toward the encephalon, and 
endangering the augmentation of any hyperaemic condition, that may be 
existent there. Still, in the opinion of many, no mischief, — but rather 
advantage, — accrues in those very cases from the use of emetics. 

Emetics differ greatly in the period that elapses between their admin- 
istration and operation, and also in the degree in which they induce 
nausea. The sulphates of zinc and copper, for example, act speedily ; 
whilst the tartrate of antimony and potassa, or ipecacuanha, requires 
fifteen or twenty minutes. This fact has given rise to a division of 
emetics into direct and indirect, or in other words, into such as are con- 
ceived to act by impressing the nerves of the stomach primarily; and 
such as exert their agency, in the first instance, on the great nervous 
centres themselves. 

An agent of the first class is presumed to excite such a disagreeable 



GENERAL EFFECTS. Ill 

impression upon the nerves of the mucous coat of the stomach, that the 
brain immediately calls for the assistance of the different muscles con- 
cerned in vomiting, and the contents of the stomach are at once 
evacuated ; or repeated efforts are instantaneously established to effect 
their expulsion. 

■ On the other hand, an agent of the latter class is presumed to excite 
no immediately disagreeable impression upon the gastric nerves, but 
gives occasion to the act of emesis by passing into the circulatory ap- 
paratus of the stomach ; impressing the nerves distributed to the lining 
membrane of the blood-vessels ; or reaching the brain, and making its 
first impression upon that organ ; and the fact that many substances, — 
as the tartrate of antimony and potassa, — which, as regards its agency 
on the stomach, is equally soluble with the sulphates of zinc or copper, 
— require such a length of time before their effects are produced, com- 
pared with those last salts, is favourable to the latter opinion. Only 
one other view could indeed be indulged, and it is sufficiently difficult 
of comprehension ; — that in the case of the salt of antimony a more 
protracted impression on the gastric nerves is required than in that of 
the salt of zinc ; yet how this can be effected by a solution, capable of 
such ready absorption, is by no means clear. 

The rapid emetics, as a general rule, excite the least nausea, and their 
action is soonest over. The vegetable emetics are generally attended 
with more nausea than the mineral ; although the tartrate of antimony 
and potassa, which requires about the same time before its operation 
commences, is considerably nauseant ; and is more frequently employed 
to excite nausea, where such agency is demanded, than any other sub- 
stance belonging to the class. The effects of substances, which require 
time for action, supervene more gradually, and continue longer. As a 
general rule, too, the rapid emetics are not productive of as much retching 
as the others ; and hence a judicious selection of a particular emetic for 
a special morbid condition, or to fulfil a certain indication, may be im- 
portant. Where the object is simply to evacuate the contents of the 
stomach, a rapid emetic, and one that is neither accompanied in its action 
with .nausea or retching, is indicated. On the other hand, where a 
powerful nervous impression has to be made, one of an opposite charac- 
ter is demanded. Hence it is, that if a noxious substance be taken into 
the stomach, recourse is had to the sulphate of zinc or the sulphate of 
copper; whilst, in an attack of intermittent, where we are desirous of 
more powerfully impressing the nervous system, the tartrate of antimony 
and potassa, or ipecacuanha, or a combination of both, may be selected. 
When an emetic is given for the purpose of simply evacuating the 
contents of the stomach in disease, fluid — as warm water, or warm 
chamomile tea, or mustard and water, or a few drops of solution of 
ammonia in water — may be used, especially after each act of vomiting, 
• for the purpose of preventing retching. The fluid must, however, be 
allowed in moderation; and, where a soluble poisonous article has 
been taken, but little should be permitted, unless it can be removed 
from the stomach by the, stomach-pump immediately after it has been 
swallowed, or is likely to be evacuated at once under the action of the 
emetic. » Hence, " dry vomiting" is advised in such cases. Where the 



112 EMETICS. 

tartrate of antimony and potassa is administered to children as an emetic, 
it may be well to allow the child to suck or drink before the operation 
comes on, as the salt, it is asserted, has been found to produce poisonous 
effects, when taken on an empty stomach. 

In his " Essays on Infant Therapeutics," recently published, (New 
York, 1849), Professor J. B. Beck has properly remarked, that whilst 
the mild emetics may be given to infants with entire safety, those of an 
active debilitating character, and which produce much nausea, are more 
uncertain ^nd energetic in their effects than in the adult. The articles 
to whichs^w alludes are antimonial emetics, which " are frequently 
hazardous to young children, and that, too, when used in doses not pe- 
culiarly large." 

Occasionally, the emetic acts for a longer time, or more severely, than 
is desirable. In such cases, a few drops of laudanum, or of laudanum 
and ether ; or a teaspoonful of brandy ; or a drop of creasote, may be 
prescribed. A teaspoonful of magnesia in a glass of sherry wine has 
been advised with the same object. These excitants are not often, how- 
ever, needed. Frequently, a mustard plaster to the pit of the stomach is 
adequate to the"emergency. 

If the object of the practitioner be to excite a new nervous impres- 
sion, the greater the amount of retching, within due limits, the better. 
At times, emetics not only produce emesis, but they excite violent 
catharsis; or they may induce the latter effect without the former. In 
such cases, a few drops of laudanum have succeeded in restricting their 
operation to the stomach. In very irritable individuals, too, the emesis 
may go to an inordinate extent, so as to exhaust by the repeated retch- 
ing and vomiting. Carbonic acid, — as contained in soda water, or as 
given off by the union of citric or tartaric acid and carbonate of soda, — 
or opium, or some topical rubefacient to the epigastric region, may be 
required to check it. 

Reference has been made to the evils resulting from the repeated 
employment of emetics as regards the gastric functions, as well as to the 
mischief they may induce in particular states of the system. One other 
inconvenience resulting from them, — or rather, said to result from them, 
but of which the author has not seen an example,— is that of inflammation 
of the extremities, followed by gangrene. M. Barbier— an eminent 
French writer on Therapeutics — has cited the following case. — A woman, 
of a constipated habit, had used many means for producing catharsis, 
but ineffectually ; when a surgeon to whom she applied, administered a 
violent preparation, which operated both upwards and downwards. 
Cramps, convulsions of the limbs, and great anguish supervened. Im- 
mediately afterwards she was attacked with severe lancinating pains of 
the extremities, and ecchymoses appeared on different parts of the body. 
Gangrene attacked the cartilaginous portion of the nose, the lower lip, 
the skin of the chin, the points of two toes of the right foot, and the 
great toe of the left, all of which successively dropped off. To this case 
M. Barbier adds one of his own. A woman of the Faubourg d'Amiens, 
having procured a cathartic remedy from an herbalist, was attacked, after 
taking it, with incessant vomiting and purging, which rapidly reduced 
her strength. She was taken to the Hotel-Dieu. Next day, the point 



i 



IN INTERMITTENT FEVER. 113 

of the nose, the ears, and the cheeks became of a deep violet hue, and 
soon afterwards the same colour spread over the feet and the hands, and 
gangrene rapidly attacked all these parts. She lost one of her feet, and 
several toes of the other. 

These cases do not seem to prove incontestably, that the gangrene 
was dependent upon the use of emetics. The effects may have been 
coincident, instead of consequent ; and if any such evil were to be ap- 
prehended from them, we ought assuredly to have on record a greater 
number of examples. 

Therapeutical Application of Emetics. 

After this full investigation of the general effects consequent on the 
administration of emetics, their therapeutical application to particular 
diseases will be intelligible. 

Intermittent fevers.-~-In intermittent fevers, they are employed with 
two objects, — either to excite a powerful nervous impression, or to 
simply evacuate the contents of the stomach ; and, according as the 
practitioner has one or other of these objects in view, he selects his 
particular emetic. 

For exciting a powerful nervous impression, one which produces 
much nausea and vomiting is, as already inculcated, to be preferred ; 
whilst if simple evacuation be desirable, it matters not how trivial the 
nausea or disorder may be. Practitioners, however, generally have re- 
course to the tartrate of antimony and potassa, and ipecacuanha, singly 
or combined. The latter is perhaps the more certain agent ; and it has 
the advantage, that no very great attention is required to the dose, — 
sixty grains not usually producing more effect than thirty. 

Where the object is to arrest the paroxysm of an intermittent, the 
emetic should be exhibited a short time before the cold stage is ex- 
pected ; and should it even not have the effect of completely prevent- 
ing the fit, it may essentially mitigate it. 

The first impression, made by an emetic of antimony, or of ipecacu- 
anha, is one of diminished action ; the second is one of equalization ; so 
that although the former operation might appear inappropriate in a case 
of diminished action, like that of the cold stage of an intermittent, the 
latter might be decidedly advantageous; and this latter, it would seem, 
predominates over the former, inasmuch as no evil is found to result 
from the employment of emetics in the cold stage. Even in those per- 
nicious or congestive intermittents, — the febres algidce, as they have 
been termed, — in which reaction, if established at all, is so with diffi- 
culty, they have been found decidedly useful. In such cases, emetics, 
which produce the equalization without the depression, are obviously 
indicated — as sulphate of zinc, or sulphate of copper ; — but those of 
the indirect kind have been exhibited with impunity, and even with ad- 
vantage. 

In the hot stage, emetics have likewise been 'given, but they seem to 
make less impression where all is exaltation, and they are obviously not 

Vol. I.— 8 



114 EMETICS 

so much indicated as when the action is to a less extent, — although 
nauseants may be highly useful. 

The truth is, that during the paroxysm of an intermittent, it is not 
generally necessary to do much. The management on general princi- 
ples is alone necessary ; — hot fluids being prescribed in the cold stage ; 
cold in the hot ; and tepid in the sweating. 

In the state of apyrexia, emetics prepare the way for the administra- 
tion of tonics, which are thus enabled to come' into more immediate 
contact with the lining membrane of the stomach, and to exert their ap- 
propriate agency on it, and through it, on the rest of the nervous system. 
In all periods of the affection, a gentle emetic, given merely to remove 
morbid secretions, may be advantageous, but their repeated use must be 
avoided. 

Remittent fevers. — In remittent fevers, which are commonly accom- 
panied by more or less excitation in the lining membrane of the stomach 
and intestines — especially of the upper portions — active emetics are not 
advisable ; but gentle evacuants may be administered not only without 
detriment, but with advantage. Their repeated use, however, in such 
cases, is apt to augment the irritation already existing in the mucous 
membrane of the digestive tube, and to increase the sensibility of that 
of the stomach in particular. 

Fevers in general. — From the equalizing effect of emetics, they may 
be used at the commencement 'of almost all fevers with advantage; and, 
at times, they would appear to cut short the complaint, although proba- 
bly much less frequently than has been imagined. 

In cases of ephemera, which most frequently occurs in children, but, 
at times, in adults also, and is dependent upon gastric disorder pro- 
duced by errors in diet, emetics are obviously indicated ; and by re- 
moving the cause of the fever, they may put an end to the febrile action ; 
but it is not easy to cut short a continued fever, after it has gone on for 
some days, by this or by any other plan. Such, at least, has been the 
result of the author's observation, and it accords with that of others, 
whose opportunities have been extensive. In almost all fevers, termed 
1 continued,' two exacerbations in the day can be perceived ; — the one 
about mid-day, and the other in the evening ; and it has been conceived, 
that where the object is to cut short the fever, the emetic, as in the case 
of an intermittent, should be given a short time before the expected ex- 
acerbation, and especially before that in the evening, which is usually 
more marked than the other. 

The modus operandi of emetics, in cutting short a continued fever, 
is the same as in the case of intermittents, — by the revulsion they pro- 
duce ; and the equalizing influence exerted by them on the sanguiferous 
and nervous systems. Hence, they are occasionally advantageous in 
the major exanthemata, especially when the eruption does not appear 
freely and equably, but seems to be restrained or repressed, in conse- 
quence of irritation existing in some internal organ. Broussais with 
the dogmatism that is too apparent in his writings, lays down a law of 
action, which admits of many exceptions. — " Emetics cure ^astro-ente- 



IN PHLEGMASIA. 115 

ritis solely by the revulsion, and the critical evacuations which they 
provoke ; their effect is then uncertain in mild cases ; and, in severe 
ones, they are always dangerous, because they never fail to augment the 
inflammation when they do not succeed in removing it." — Prop. 287. 
And, again ; — "Emetics, purgatives, and tonics, which act by revulsion, 
affect only temporary cures in chronic gastritis and gastro-enteritis, and 
render the radical cure more difficult." Prop. 349 ; — " propositions," 
which must be regarded as mere assertions emanating from a distin- 
guished source, but not on that account to be received as authority, in 
the absence of evidence. 

It need scarcely be said, that in the course of continued fever, mor- 
bid secretions must take place from the lining of the alimentary tube as 
in remittents and intermittents, but as these can generally be evacuated 
by cathartics, they are usually employed to the exclusion of emetics. 

Inflammations. — In the different phlegmasia^, emetics are much used. 
In some, however, they are more effective than in others. In laryngo- 
tracheitis or croup, they are given in very different stages of the disease, 
to fulfil different indications, and with equal propriety. At the com- 
mencement of an attack, both of spasmodic and inflammatory croup, an 
emetic, by exciting a salutary revulsion and equalizing the circulation, 
frequently puts an end to the affection ; and even if the disease has 
made some progress, it is a valuable agent after blood-letting. Accord- 
ingly, it is one of the remedies most employed in the early stages of 
croup. 

It is equally indicated after the plastic secretion has been thrown 
out from the membrane ; but when it has formed in the trachea, it 
must obviously be a matter of extreme difficulty, by any agency, to 
cause the detachment of the false membrane, and its expulsion through 
the narrow chink constituting the rima glottidis ; yet the best expecto- 
rant agency that can be exerted is effected by the succussion which the 
action of an emetic occasions. 

The same remarks apply equally to the inflammation of the lining 
membrane of the larynx, that constitutes laryngitis. 

In amygdalitis or inflammation of the tonsils, as well as in pharyngitis 
and oesophagitis, the same good effects are produced by the revellent 
and equalizing agency of emetics ; and when suppuration has super- 
vened, and the abscess is seated so low down in the pharynx or oeso- 
phagus, that it cannot be reached by the instrument of the surgeon, the 
operation of an emetic may cause it to break. With this view, one of 
the direct emetics may be prescribed. No great impression on the ner- 
vous system is needed. The expulsive efforts are alone required ; and 
the sulphate of zinc, or the sulphate of copper, is capable of fulfilling 
every indication. In the malignant varieties of cynanche, which so often 
accompany scarlatina, emetics are frequently administered. Much cura- 
tive influence cannot, however, be expected from them, except at the 
very commencement of these affections ; but at a subsequent period, 
they may be given with the view of removing the viscid secretions, 
which excite so much annoyance. 



116 EMETICS 

Diseases of the chest.— Emetics are much employed in different dis- 
eases of the chest. In pneumonia, they are not often used before the 
activity of vessels has been diminished by the proper antiphlogistic 
remedies ; but when the inflammation has been somewhat subdued, 
their equalizing and revulsive influence becomes strikingly apparent. 
They favour the discharge of the bronchial secretions, by the succussion 
they communicate to the lungs ; and, for this reason, they are employed 
with considerable benefit in chronic bronchitis. 

They are, likewise, extremely beneficial in nervous cough, hooping- 
cough, and asthma. These diseases appear to be dependent upon a 
morbid condition of the nerves of the respiratory organs — the pneumo- 
gastric especially — which occasions contraction of the muscular fibres, 
that surround the minute bronchial ramifications ; and this state of the 
nerves is generally perhaps connected with more or less derangement of 
the parts of the cerebro-spinal axis, whence they originate. Hence, the 
utility of producing a revulsive effect, by means of emetics or other 
agents. Expectoration is also favoured by them in the manner just 
mentioned, and it has been long remarked, that those children suffer 
least from hooping-cough, who readily eject the contents of the stomach 
during each fit of coughing. 

Diseases of the encephalon. — It is in head affections that the use of 
emetics might seem most doubtful. In encephalitis, they are generally 
esteemed inadmissible; and, as the pain in the head is almost intoler- 
able, their operation can hardly fail to aggravate the symptoms, notwith- 
standing their revellent and equalizing tendency. The same remarks 
are applicable to their employment in apoplexy. As the violent efforts 
force the blood with great impetus to the head by the arteries, and 
retard its return by the veins, they appear inappropriate in cases in which 
hyperemia already exists in the encephalon, yet their revellent proper- 
ties would seem to have rendered them useful in ophthalmia, when 
blood-letting, counter-irritants, &c, had been prescribed, and the dis- 
ease had, notwithstanding, remained stationary. In these very cases, 
the same substances, employed so that their operation may be confined 
to exciting nausea, are amongst our most valuable remedies, and not in 
these affections only but in every variety of phlegmasia. 

Amaurosis. — Amaurosis is said to have been beneficially treated by 
emetics, but much reliance obviously cannot be reposed on them, when 
the retina, or the optic nerve, or the part of the brain in which the optic 
nerve arises, is affected with paralysis. Impaired or depraved vision 
often occurs sympathetically from disorder of the digestive functions ; at 
other times, it is owing to lesion of the eye itself, or of the encephalic 
part of the organ of vision ; hence the affection termed myodesopsia or 
muscce volitantes is symptomatic of one or other of these morbid condi- 
tions ; and hence the various hallucinations, illusions or waking dreams, 
which occur in diseases of the encephalon, — as mania and hypochon- 
driasis, but which are often produced in persons of sound mind, whose 
nervous systems are unusually impressible, and easily acted upon by 
irritations in the stomach, or elsewhere. 

Where the primary mischief in such affections is in the stomach or 



IN DISEASES OF THE ALIMENTARY CANAL. 117 

intestines, emetics are more likely to afford relief than when it is seated 
originally in the encephalon. 

Bubo and orchitis. — In certain local affections — as bubo and orchitis 
— the revellent action of an emetic is often beneficial. The inflamma- 
tion may have been vigorously attacked by the proper antiphlogistic 
measures, yet the swelling may remain stationary. If a powerfully 
revellent nervous impression be now made by exciting emesis, the 
swelling will frequently disappear. 

In the very early stages of orchitis, or bubo, the revulsion, thus in- 
duced, is by no means as efficacious. The excited state of vessels 
generally predominates too much to be broken in upon by any impres- 
sion upon the nervous system. The state of vessels must be reduced 
by antiphlogistics, and then emetics may be had recourse to with full 
advantage. 

Phthisis pulmonalis. — In phthisis pulmonalis, emetics were at one 
time considered the best remedies: and, according to one writer, Dr. 
Young, % a majority of the cures of phthisis have been effected by them 
or by nauseating agents. This idea probably originated from the good 
effects observed to follow a sea voyage, which is usually accompanied 
by sea-sickness ; but the fallacy, in this case, consists, in referring that 
to the nausea, which may have been produced by the greater equability 
of temperature at sea, and by the new impressions made upon the mind 
and nervous system of the voyager, through the altered barometrical, 
hygrometrical, thermometrical, electrical and other conditions of the 
atmosphere, and by the new scenes in which the patient was placed. 
Even in the early stages of phthisis, when alone any course of medica- 
tion can be expected to be effective, emetics are, at the present day, 
rarely had recourse to. In the later periods of the disease, they are not 
only useless, but add to the existing irritation and debility. 

Diseases of the alimentary canal. — In gastritis, and enteritis, emetics 
are manifestly not needed, and would probably be injurious ; nor would 
they appear to be indicated in spontaneous vomiting ; but, as diarrhoea 
is often kept up by irritants in the intestinal canal, and requires the 
administration of a cathartic to remove them, so vomiting may suggest 
the use of an emetic ; and even when spontaneous vomiting has persisted 
after the contents of the stomach have been evacuated, the new action 
induced by an emetic may break in upon the disorder of function, and 
remedy the evil. 

In dyspepsia, emetics are occasionally prescribed, but they must be 
employed with caution. A gentle emetic removes indigestible matters 
and morbid secretions, and produces an excitation in the stomach which 
may be salutary; but repeated emetics, as has been previously shown, 
may injure the tone of the organ, develope its sensibility, and augment 
the very affection for the removal of which they were administered. 

In cholera — both of the indigenous, and exotic variety — gentle eme- 
tics are prescribed by some practitioners, and as means for the removal 
of morbid secretions they may be useful ; but it is not clear, that they 
ought to be regarded as of much efficacy in affections that are dependent 
upon an irritated or excited state of the gastro-enteric mucous mem- 
brane, and which yield with the subsidence of the inflammatory irrita- 



118 EMETICS 

tion,— or terminate unfavourably, when the morbid affection of the 
membrane in general, and of the exhalants in particular, is excessive. 

In cases of 'malignant cholera , the stimulating emetics — as mustard — 
have been most frequently employed,— the erethism of the mucous 
membrane in these malignant cases being occasionally diminished by 
gentle excitants, as we have seen it may be in affections of the mucous 
membranes in general, when the over-distended sta,te of extreme vessels 
is the prominent pathological lesion. A main part of the benefit, how- 
ever, accruing in such cases, may be derived from their revulsive 
operation, — the chief pathological mischief being usually situate lower 
down in the tube. It has, indeed, been a question, with some thera- 
peutists, whether advantage might not be derived, in these unfortunate 
cases, from remedies that might even inflame the lining membrane of 
the stomach ; but such a harsh plan of revellent treatment could, of 
course, be scarcely admissible. 

In diarrhcea and dysentery, where the irritation is seated low T down 
in the tube, an emetic may produce good effects as a revulsive ; but, in 
the latter disease, the violence of. the inflammation must be previously 
subdued by appropriate agents. It would seem, too, that in certain 
cases of constipation, accompanied with spasmodic constriction of the 
muscular coat of the intestines, emetics, administered after blood-letting, 
have relaxed the spasm, so that the bowels have been relieved, or gentle 
cathartics have afterwards been sufficient. 

In dysentery, the seat of which is chiefly in the lining membrane of 
the large intestine, the revellent and equalizing effects of emetics are 
beneficially manifested. 

Rheumatsim 'and gout. — In acute rheumatism and gout, emetics are 
not much used, although occasionally their operation — as revellents 
and equalizers — may be advantageously exerted. In the latter disease, 
connected as it is with considerable gastric disorder, their use might 
seem to be more especially indicated ; and in both diseases they may 
be demanded for the removal of morbid secretions, or of undigested 
matters from the tube, — a result, which can generally, however, be 
accomplished by the use of gentle cathartics. 

Hemorrhages. — After what has been said of the general mode of 
action of emetics, and of their application to the ordinary phlegmasia?, 
their agency in hemorrhages will be apparent. In epistaxis, they 
cannot be required, and their employment in apoplexy, — it has been 
already seen, — is a more than questionable measure. The same, it has 
been thought, may be said of hemoptysis. Although their equalizing 
and revulsive operation might act favourably, it has been conceived, 
that the activity they occasion in the vascular movements might more 
than compensate for their salutary agency. Yet, it has not been found, 
that haemoptysis, symptomatic of phthisis, has recurred, or been in- 
creased at sea during the retching of sea-sickness. In such cases, 
nauseating doses are recommended, which, as before shown, produce 
an effect of a directly opposite character, so as to give occasion to their 
being classed amongst agents that diminish action. 



IN HEMORRHAGES. 119 

In hcematemesis, emetics have been recommended by some, with the 
view of removing the accumulations of blood that form in the stomach ; 
and, in this respect, they may be of service. The hemorrhage, in these 
cases, is generally venous, and takes place by diapedesis or transuda- 
tion, — often owing to visceral engorgement, which prevents the blood 
from circulating freely in the engorged organ, and occasions irregular 
congestions in other parts. In such cases, emetics ought to be adminis- 
tered with caution. In the wards of the Philadelphia Almshouse, the 
author annually met with cases of hsematemesis, melsena, and epistaxis, 
occasioned by engorgement and induration of the liver or spleen — 
especially the latter, acquired in malarious districts. The proper treat- 
ment of the hemorrhage necessarily merges in that of the primary affec- 
tion on which it is dependent. 

In cases of simple hsematemesis, the action of the stomach, induced 
by an emetic, may occasion the removal of the venous congestion, and 
the pressure of the muscular coat of the viscus on the vessels exhaling 
the blood may tend to contract their dimensions, and to arrest the flow, 
somewhat, perhaps, in the manner that the hemorrhage is arrested in 
the next variety to be considered. 

Uterine hemorrhage may occur prior to, during, and subsequent to, 
the delivery of the child. In all cases, it is produced by a discharge 
from the uterine vessels. The old idea, universally entertained, was, — 
that the vessels of the mother pass directly to the placenta, and pour 
their blood into the maternal portion of that organ. -Under this view of 
the subject, which modern researches prove to be the most correct, he- 
morrhage would be produced by a rupture of the maternal vessels. Some 
observers have satisfied themselves, that there is no direct communication 
between the uterine vessels and the placenta, but that these vessels 
coast along the uterine parietes in a direction parallel to the placenta, — 
having, however, portions scooped out of their sides, which portions 
are closed, either directly or indirectly, by the placenta. Under this 
view, there can of course be no maternal and foetal portions of the 
placenta ; the whole is fcetal, and hemorrhage arises from the detach- 
ment of the decidua or of the placenta from the apertures in the uterine 
vessels. Under either view, whatever induces contraction of the uterus, 
occasions the reapplication of the placenta, or of the body of the child 
to the vessels whence the hemorrhage proceeds, and arrests it. These 
remarks apply, of course, only to hemorrhage occurring prior to, or 
during delivery, and then only to cases in which the placenta is situate 
elsewhere than over the os uteri. 

In uterine hemorrhage following the delivery of the ovum, the hemor- 
rhage is arrested by causing the uterus'to contract upon itself, and thus 
to obliterate, as it were, the maternal vessels ; and emetics, which call 
into action the abdominal muscles, facilitate this result, although they 
are but rarely had recourse to, seeing, that the obstetrical practitioner 
has more immediate and effectual means for attaining his object. 

• Jaundice. — In jaundice, dependent — as it often is — on some impedi- 
ment to the flow of bile along the biliary ducts into the duodenum, and 
especially when produced by a gallstone, the inverted action and the 



120 EMETICS. 

succussion, induced by the operation of an emetic, are often beneficial ; 
and the same remark holds good in cases of cholelithus or gallstone 
without jaundice. Here, an emetic should be selected, whose opera- 
tion is preceded by nausea — as tartrate of antimony and potassa, or 
ipecacuanha — the relaxing influence of which is first felt, and imme- 
diately afterwards the propulsory efforts follow, which are, at times, 
successful in causing the calculus to clear the biliary passages. It has 
been properly remarked, however, that emetics are more advantageous 
and safe in the early than in the later periods of jaundice when there is 
reason to believe in the existence of organic disease of the liver; and 
also, that they should be used with caution, when there is evidence of 
distention of the gall-bladder, — indicated by a tumour felt on pressing 
the right hypochondriura. Under such circumstances, the operation of 
an emetic has been known to occasion rupture of the gall-bladder and 
fatal peritonitis. 

Neuroses. — In mental alienation, emetics were at one time much 
advised, and some of the most noted remedies possessed properties of 
this kind. They are not given at the present day, unless symptoms 
should arise in the course of the disease to indicate their administration. 
In the cases in which they are presumed to have exerted a salutary 
agency, this was probably accomplished less by their acting as evacu- 
ants, or through modifications induced in the circulation, than by the 
new impression made by them upon the nervous system. Hence, they 
are occasionally used in mania to interrupt intense abstractions. When 
the insane obstinately determine to retain the urine and fasces, an 
emetic often succeeds in breaking in upon the determination ; and the 
same applies to those who are affected with delirium tremens, in which 
disease emetics have been wholly relied on by some. (For the author's 
views on this subject see his Practice of Medicine, 3d edit, ii., 248, 
Philadelphia, 1844.) In all such cases, emetics have to be given in 
larger doses than usual. The encephalon being in a state of excite- 
ment, and employed in its own acts, is less affected by impressions 
made on other organs; and, consequently, requires a, larger amount of 
the impressing agent ; but if the energy of the system be first reduced 
by a copious abstraction of blood, the ordinary dose of the emetic may 
produce its accustomed effects. 

In hypochondriasis, which is an encephalic disorder, accompanied 
generally with much gastric derangement, an occasional emetic is often 
beneficial, by exciting a new action in the nervous system, and giving 
an impulse to functions carried on with unwonted torpor. 

In epilepsy, and in the convulsions of children, emetics are not only 
excellent prophylactics, but valuable curative agents. Where organic 
mischief does not exist, these diseases are usually induced by great 
mobility, or impressibility of the encephalon, developed by irritation in 
some distant part of the system, and especially in the digestive tube. 
Often, this is produced by indigestible diet, or by morbid secretions, 
and when the prodromic or premonitory symptoms of the attack are 
present, a timely emetic may prevent the paroxysm, by removing the 



SPECIAL EMETICS. 121 

cause, and exciting a new nervous impression, as in the case of intermit- 
tents. 

The same kind of revulsion is, at times, salutary in hysteria, as well 
as in the different forms of neuralgia. The impression of the emetic 
is powerfully exerted on the stomachy whence it irradiates to every part 
of the nervous system ; and, by equalizing the nervous distribution or 
influx, detracts from its intensity in any given point. 

Dropsy. — Lastly ; — emetics have been frequently exhibited in the dif- 
ferent varieties of dropsy ; and in such cases they are calculated to act 
as promoters of absorption ; — not so much in consequence of any 
increased action of the exhalants of the lining membrane of the stomach, 
which they may occasion, as by their revulsive operation. Dropsies, as 
will be seen, have been known to disappear under powerful mental 
emotions, and not only dropsies, but depositions of solid materials ; and 
we can, therefore, understand, that these affections may diminish under 
the nervous derivation excited by an emetic. They cannot, however, 
be repeated sufficiently often to produce much salutary influence, for 
fear of injuring the tone of the stomach ; and, accordingly, they are but 
rarely employed in the treatment of hydropical affections. 

Such are the main diseased conditions in which emetics are espe- 
cially serviceable. It is obviously impossible to specify every variety 
of organic lesion in which they may be salutary. Enough has been 
said of their general properties, and particular applications, to suggest 
the cases in which their administration may be indicated. 



SPECIAL EMETICS. 
a. Direct Emetics. 

1. ZINCI SULPHAS.— SULPHATE OF ZINC. 

Sulphate of zinc occurs in commerce in an impure state, under the 
name of White Vitriol ; by which, indeed, it was long known in medi- 
cine. The salt, however, always contains iron, and commonly popper 
and lead ; and therefore, for pharmaceutical purposes, it is directed to 
be prepared by the union of oxide of zinc and sulphuric acid. It is in 
colourless crystals, which effloresce on exposure to the air. It is wholly 
dissolved by water, by 2 T 2 % of its weight of cold water, and by less 
than its own weight of boiling water. It is insoluble in alcohol. The 
solution in water affords with ammonia a white precipitate, which is 
redissolved by the alkali in excess. It also yields white precipitates 
with chloride of barium, ferrocyanuret of potassium, and sulphohydrate 
of ammonia. 

Sulphate of zinc, which is tonic in small doses, is a rapid and safe 
emetic ; and hence is given, when it is desirable to evacuate the con- 
tents of the stomach speedily, as when poison has been taken. The 
dose for this purpose is from ten to thirty grains. In excessive doses it 
acts as an irritant poison. 



122 SPECIAL EMETICS. 

■2. CUPRI SULPHAS.— SULPHATE OF COPPERS 

Sulphate of Copper, Roman or Blue Vitriol, Blue-stone, used in (he 
United States, is formed by a direct combination between old scrap 
copper and sulphuric acid. This is always made on the large scale ; 
and hence it is not in the list of preparations of the Pharmacopoeia of the 
United States, but in that of the materia medica. It occurs in rich blue 
crystals, which are wholly soluble in water, and slightly efflorescent in 
the air. It is insoluble in alcohol. Ammonia throws down, from a 
solution of the salt in water, a precipitate, which is entirely redissolved 
when the ammonia is added in excess. It dissolves in about four parts 
of water at 60°, and two parts of boiling water. 

Like sulphate of zinc, it is, in very small doses, tonic; and in larger 
emetic. It is, however, much more active, and in considerable doses 
is a highly acrid and corrosive poison. Its dose, as an emetic, is from 
two to tive grains, given in water ; but it is less safe than the sulphate 
of zinc. 

3. ALU'MEN.— ALUM. 

This salt — the main properties of which are described under the head 
of mineral astringents — has* been much employed by Dr. Meigs, of 
Philadelphia, and his son Dr. J. F. Meigs, as an emetic in croup. The 
former states, that he has been familiar with its effects for more than 
twenty years, and that his confidence in it, as a certain and speedy 
emetic in such cases, increases rather than diminishes by time. He has 
never, he thinks, given more than two doses without causing very full 
vomiting; but has often given large quantities of antimony, antimonial 
"wine and ipecacuanha without their occasioning the desired effect. It has 
the advantage, also, of operating without occasioning more exhaustion or 
prostration than always follows the act of vomiting. 

It is best prescribed in powder, mixed with honey, syrup of any kind 
or molasses. The dose is a teaspoonful, mixed with an equal or double 
the quantity of the vehicle, and repeated in ten, fifteen, or twenty min- 
utes, should the first dose fail to produce free vomiting. It is seldom 
necessary to give a second dose. 

4. HYDRAR'GYRI SULPHAS FLAVUS.— YELLOW SULPHATE OF MER'CURY. 

This salt of Mercury, called also Subsulphate of Mercury and Tur- 
peth Mineral, is obtained by throwing a sulphate of mercury into boil- 
ing water. It is a lemon-yellow powder, almost insoluble in water; dis- 
solving in about 2000 parts of cold water, and in about 600 parts of 
boiling water. 

It is in large doses a violent corrosive poison. It is occasionally, 
but rarely, given as an emetic ; its operation having been regarded as 
very severe, and at times followed by ptyalism. Dr. Hubbard, of Maine, 
has been, however, in the habit of employing it largely, in cases of 
croup, and recommends it strongly on the ground of its promptness of 
action. It does not produce catharsis, nor is its action followed by 
the prostration which, at times, follows that of tartrate of antimony 
and potassa. 



ANTIMONII ET POTASSiE TARTRAS. 123 

The dose, as an emetic, is from two to five grains. Dr. Hubbard 
prescribes from two to three grains to a child two years old, and re- 
peats the dose in ten or fifteen minutes until emesis is induced. 

b. Indirect Emetics. 

5. ANTIMO'NII ET POTAS'SjE TARTRAS.— TARTRATE OF ANTl'MONY AND 

POTAS'SA. 

Tartrate of Antimony and Potassa, Tartarized antimony, Emetic 
Tartar, Tartar Emetic — in the Southern states of the Union erroneously 
termed Tartar — is, perhaps, more frequently used as an emetic than 
any other agent. 

In the Pharmacopoeia of the United States (1842) it is directed to be 
formed as follows : — Take of Sulphur et of .Antimony, in fine powder, 
§iv. ; Muriatic JJcid, Ixxv. ; JVitric Jlcid, 3\j - ; Water, a gallon. To 
the acids mixed in a glass vessel, add gradually the sulphuret of anti- 
mony, and digest the mixture with a gradually increasing heat till effer- 
vescence ceases ; then boil for an hour. Filter the liquor when it has 
become cool, and pour it into the water. Wash the precipitated pow- 
der frequently with water, till it is wJiolly freed from acid, and then dry 
it. Take of this powder, 3ij. ; Bit art rate of Potassa, in very fine 
powder, §iiss. ; Distilled water, f. §xviij. Boil the water in a glass 
vessel; add the powders previously mixed together, and boil for an 
hour; filter the liquor whilst hot, and set it aside to crystallize. By 
further evaporation, the liquor may be made to yield an additional 
quantity of crystals, which should be purified by a second crystalliza- 
tion. 

Tartrate of antimony and potassa consists of tartrate of antimony and 
tartrate of potassa ; and the object of the above process is first to form 
sesquioxide of antimony, and then to saturate with it the excess of acid 
in the bitartrate of potassa. It is in transparent crystals, which become 
opaque and white on exposure to the air. As met with in the shops, it 
is generally in powder, and, when pure, is perfectly white. Dr. Pereira, 
however, remarks, that some ignorant druggists prefer a yellowish-white 
powder ; and he was informed by a manufacturer of the salt, that he 
was obliged to keep two varieties, — one white, the other yellowish- 
white, — to meet the demands of his customers. The yellow hue is 
owing to the presence of iron. 

It is often adulterated with bitartrate of potassa ; and it has been found 
that it may contain 10 per cent, of it, and yet dissolve in the proper 
quantity of water. It is wholly soluble in 14 or 15 parts of water, ac- 
cording to Dr. Pereira ; — according to the Pharmacopoeia of the United 
States, in '20, at 60° Fahr. Uncombined bitartrate of potassa is detected 
by adding a few drops of a solution of carbonate of soda to a boiling 
solution of the antimonial salt. This causes a precipitate, which is im- 
mediately redissolved, if bitartrate of potassa be present. 

When tartrate of antimony and potassa is taken in very large doses, 
it acts as a powerful irritant poison, causing directly inflammation of the 
stomach and intestines. It is likewise an irritant when applied to the 
cutaneous surface. Its nauseant and emetic properties alone fall under 



124 SPECIAL EMETICS. 

consideration in this place. As a nauseant, it is constantly given in fe- 
brile and inflammatory affeotions, in such doses as to keep up the action 
of sedation sufficiently long to break in upon the chain of morbid asso- 
ciations. For this purpose, it is prescribed in the dose of from | to J a 
grain every two or three hours; carefully regulating the quantity, and 
the periods, so as to prevent the supervention of vomiting. As an 
emetic, it may be given alone, or in union with ipecacuanha, — one or 
two grains of the tartrate to fifteen or twenty grains of the latter. When 
administered alone, it should be in divided doses ;— six grains, for ex- 
ample, being dissolved in four ounces of water, and a fourth part given 
every fifteen minutes until it operates; — the action, in this case, as in 
that of every other emetic, where it is desirable to evacuate the contents 
of the stomach freely, and there is no danger of dissolving any noxious 
matter that may be contained in it, being aided by drinking freely of 
warm water, or of warm chamomile tea. For reasons already assigned, 
it is rarely prescribed, however, where any poisonous agent has been 
taken, — recourse being then had to direct emetics. Being devoid of 
taste, it is a very convenient emetic in the diseases of infancy, in which 
it is advisable to give it in divided closes until vomiting is induced ; and 
it is doubtless the main agent in some of the nauseating and emetic pre- 
parations so commonly used in such cases in domestic practice. It has 
been already remarked, that some caution is needed in its administra- 
tion to young subjects. Professor Hamilton, of Edinburgh, from thfe 
observation of one or two cases in which its operation was attended with 
unpleasant gastro-enteric disturbance, was disposed to consider, that it 
is apt to act as an irritant poison when the stomach is empty ; whilst it 
may be innoxious if the child has sucked, or drunk some fluid pre- 
viously ; and Professor J. B. Beck, of New York, considers, that 
" where the object is simply to evacuate the stomach, it ought never to 
be thought of; and that it should not be prescribed except in cases 
where, as in croup and pneumonic inflammation, a sedative effect is re- 
quired, and can be borne with safety." And he adds: — "It is perhaps 
hardly necessary to say, that if Tartar Emetic be an article of such dan- 
ger, the younger the subject to whom it is given, the more likely is it to 
do harm. In children under a year, I should say, as a general rule, it 
ought never to be used. During that period, the powers of life are too 
feeble to bear so active a remedy, at the same time that all the benefi- 
cial effects of an emetic may be gained from the use of ipecacuanha, or 
even milder means." 

The Author has never seen the inconveniences depicted by Dr. Beck 
and others, and he is of opinion that they will rarely or never supervene 
if fluid be allowed freely during the emetic action of the antimonial. 

VDTOM ANTMO'NII, ANTIMO'NIAL WINE.— {Antim. et Potass. Tartrat. 9j.: 
Vint f.^x.) Each fluidounce of the wine contains two grains of the 
tartrate. 

Antimonial wine is commonly kept in families, and it has the advan- 
tage, which a watery solution has not, of keeping well. It is readily 
taken by children for wine. It is not well adapted, however, as an 
emetic for the adult. If we regard the ordinary dose of the tartrate of 
antimony and potassa to be two grains, it would require one ounce of 



IPECACUANHA. 



125 



Fig. 1. 



the wine, which might, in many diseases, be injurious, and in no circum- 
stances could offer advantages over the aqueous solution. Accordingly, 
it is rarely prescribed to adults. To children under five years of age, 
the vinum antimonii is generally given in the dose of a tea-spoonful, 
and repeated every fifteen or twenty minutes until it acts. 

6. IPECACUAN'HA. 

Ipecacuanha is the root of Cephaelis Ipecacuanha ; Sex. Syst. Pen- 
tandria Monogynia ; Nat. 
Ord. RubiaceaB, — Cincho- 
naceae (Lindley) ; a small 
shrubby plant, which grows 
in Brazil, in moist, shad) 
situations, between the 8th 
and 20th parallels of south 
latitude. It is said, also, to 
occur in New Grenada, and 
in some of the West India 
islands. The roots are ga- 
thered at all seasons of the 
year, but .especially from 
January to March inclusive. 
The amount on which duty 
was paid in England, in 
1841, was 9,623 lbs. ; but a 
singular fluctuation as to 
quantity is presented by the 

table of imports for the last Cephaelis Ipecauanha. 

few years, which is as follows : (Pereira.) 




In 1834, 


9,038 lbs. 


In 1838, 


12,426 lbs. 


1835, 


7,469 


1839, 


7,453 


1836, 


11,437 


1840, 


6,483 


1837, 


11,435 


1841, 


9,623 



As imported, ipecacuanha consists of the proper knotty root, the thin- 
ner, woody cylindrical portion by which it is attached to the stem, and 
frequently a part of the trailing portion of the stem also. The annulated 
or ringed portion — Radix Ipecacuanhce annulatce fuscce of continental 
writers — is the most active part, and, therefore, ought alone to be used 
by the apothecary. The root — as we meet with it — is of about the 
thickness of a small goosequill, and of a length varying from two inches 
to seven ; contorted, and presenting numerous annular grooves, which 
give it a characteristic, knotted or ringed appearance. The colour 
varies, from brownish, reddish-brown, grayish-brown to gray. Its sub- 
stance consists of two parts — the one constituted of the bark, the other 
of the meditullium, — the proportion, in 100 parts of good ipecacuanha, 
being 80 of the former to 20 of the latter. The meditullium is nearly 
inert, and as it is pulverizable with more difficulty than the cortical por- 
tion, when the pulverization is effected in a mortar it may happen, that 



126 



SPECIAL EMETICS. 




Brown Ipecacuanha root. 

a. Ringed portion. — b Portion 
Without rings. (Pereira.) 

rail)' termed Emetia. 



the portion which remains last in the mortar, 
possesses scarcely any medicinal property. Gene- 
rally, however, at the present day, it is reduced 
to powder on a large scale by grinding, so that 
this separation is not observable. 

Powder of ipecacuanha has a nauseous odour, 
and on some persons produces a peculiar effect, 
— giving rise to sneezing', cough, dyspnoea, and 
all the symptoms of caUtrrhus cestivus or hay 
asthma. These symptoms pass off after a time* 
and generally with a copious secretion from the 
bronchial tubes. It would appear, that small par- 
ticles of the powder, inhaled with the air, induce 
bronchitis ; and at the same time affect, in a pe- 
culiar manner, the ramifications of the pneumo- 
gastric nerves, so as to give occasion to this 
disorder. Two friends of the author suffered 
excessively whenever they had occasion to handle 
the powder, and especially if they were present 
whilst the pulverization was going on. Its taste 
is bitter, subacrid, mucilaginous, and very nau- 
seous. It yields its virtues to water, and still more 
to alcohol, pure or diluted. The stronger wines 
equally extract them, and hence most of the phar- 
macopoeias have a wine of ipecacuanha. The 
virtues reside essentially in an active principle, 
which was first separated by M. Pelletierin 1817, 
to which he gave the name Emetine — now gene- 
Pelletier's analysis was as follows. 





Brown Annulated 


Ipecacuanha 


Red do, 




Cortex. 


Mediiullium. 


Cortex. 


Emetia, 


16 


1.15 


14 


Odorous fatty matter, 


2 


traces 


2 


Wax, 


6 





— 


Gum, 


10 


5.00 


16 


Starch, 


42 


20. 


18 


Ligneous matter, 


20 


66.60 


48 


Non-emetic extractive, 


— 


2.45 


__ 


Loss, 


4 


4.80 


2 



100 



100.00 



100 



The emetia, in this analysis, is, however, the impure ; and it was 
subsequently found by M. Pelletier, that the root contains only about 1 per 
cent, of the pure. Such are the characters of the officinal ipecacuanha. 
Other ipecacuanhas have, however, been described, and it is not surpris- 
ing, that many roots should have been substituted for the officinal variety. 
It would appear, however, that they are but little known in the trade of 
this country or of Europe. It is, consequently, not necessary to dwell 
upon them. 



IPECACUANHA. 



127 



Sfriated ipecacuanha, black ipe- Fi s- 3 - 

cacuanha, is the root of psychotria 
etnetica, — a native of Peru, which 
was, at one time, supposed to be 
the source of the true ipecacuanha. 
This would appear to be some- 
times imported into continental 
Europe, and to be confounded 
with the dark specimens of the 
true ipecacuanha. Its joints, how- 
ever, are longer ; and the surface 
is striated longitudinally. M. Pelle- 
tier found it, on an analysis, to yield 
9 per cent, of an emetic extract, 
similar to impure emetia. 

Undulated, luhite or amylaceous 
ipecacuanha is obtained from dif- 
ferent species of Richard soma, 
which inhabit open plains in Bra- 
zil. It resembles the true root, but 
is distinguished from it by having 
fewer and shallower annular -fis- 
sures, larger joints, and by the 
central woody portion being pro- 
portionally much thicker. M. Pelle- 
tier found it to contain 5 or 6 per 
cent, of an emetic extract like im- 
pure emetia, and a large quantity 
of starch. 

Another variety of white ipeca- 
cuanha is obtained in Brazil from 
ionidium ipecacuanha or viola ipe- 
cacuanha. It is much thicker than true ipecacuanha, being sometimes 




Striated Ipecacuanha Root. 

a. An old root with a well- 
marked intersection. 
6. Contorted root. (Pereira.) 



Undulated Ipecacuanha 
Root. 

a. Root of Richardsonia 

scabra. 

b. Root of a Richardso- 

nia. (Pereira.) 



Fig. 4. 




Richardsonia seabra. 



128 



SPECIAL EMETICS. 



Fig. 5. 



as large as the little finger, having only a few transverse fissures, distinct 
joints or knots, and a thick woody interior. M. Pelletier found this root 
to contain about 5 per cent, of emetic extract similar to impure emetia. 

As an emetic, ipecacuanha acts like tartrate of antimony and potassa. 
It is perhaps the safest and most certain of the indirect emetics, and 
although it is supposed to be— in large doses— an acro-narcotic poison, 
the author has never known a case, in which such symptoms have pre- 
sented themselves. Emetia, however, when injected into the venous 
system of a dog, excites vomiting in the first instance, and afterwards 
coma, which ends fatally. , ... 

To produce full emesis, ipecacuanha is often associated with tartrate 
of antimony and potassa, as remarked under that article; but it is fre- 
quently given alone. The common mode is to administer about twenty 
grains of the powder in warm water ; and to re- 
peat this quantity every fifteen or twenty minutes 
until it operates ; drinking freely of warm water 
or of warm chamomile tea. When the object is 
to excite nausea, from one to three grains may be 
prescribed at such intervals as may be deemed 
advisable. This dose will generally be sufficient, 
as an emetic, for children two or three years old. 
When it does not act on the stomach, both it and 
other emetics are apt to affect the bowels ; and 
not unfrequently they all have an emeto-cathartic 
operation. 

VINUM IPECACUANHA, IPECACUANHA WINE.-(i/?e- 
cac. contus. 3ij ; Yini Oij.) This preparation 
may be used in the same cases as antimonial wine, 
and there may be cases in which it maybe proper 
when the former is not ; for example, antimonial 
wine, in particular persons, produces griping and 
intestinal irritation, whilst the wine of ipecacuanha 
does not ; — and conversely. It is a very safe emetic 
for children. The dose to the adult is one fluid 

ounce ; to the child of from one to two years of age a tea-spoonful or 

one fluidrachm. 

STRU'PUS IPECACUANM, SYRUP OF IPECACUANHA.— 'Ipecac, in pulv. crass. 
E) ; jUlcohol. dilut. Oj ; Syrup, Oij. Prepared either by maceration or by 
the process of displacement.) From £§j to f.^ij of this preparation will 
act as an emetic, but it is not much used. It is more convenient for 
children, on whom it operates in the dose of from f.Jj to f.5ij. 




Ionidium Ipecacuanha Root 
(Pereira.) 



EMET'IA. 



Emetia Emetina, Emeta, is — as already remarked — the active princi- 
ple of Ipecacuanha, which was first separated from it in 1817 by M. Pel- 



GILLENTA. 129 

letier, of Paris. It is not officinal in the Pharmacopoeias of Great 
Britain, or in that of the United States, but has been received into many 
continental Pharmacopoeias, — as the Parisian, Batavian, Hanoverian, 
&c. There are two varieties of the active principle, which, according to 
Magendie, bear the same relation to each other as moist sugar does to 
the crystallized. One of these is termed impure, the other pure. To 
obtain the former, powdered ipecacuanha is digested with ether to dis- 
solve the fatty matter, whence it derives its disagreeable odour, and 
which possesses no emetic virtue. When the powder yields nothing 
more to the ether, it is exhausted by means of alcohol ; the alcohol is 
then evaporated in a water-bath, and the residue dissolved in cold 
water. It thus loses some of the wax, and a little of the fatty matter 
that still adhered to it. It is then mixed with carbonate of magnesia 
whereby it loses its gallic acid, is redissolved in alcohol, and evaporated 
to dryness. 

To obtain pure emetia, magnesia is substituted for the carbonate 
used in the process just described, in such quantity, that the acid exist- 
ing in the liquid may be neutralized, and that which is associated with 
the emetia be separated from it. The precipitate of magnesia and eme- 
tia must now be washed with cold water to remove the colouring 
matter, which is not combined with the magnesia ; and after being 
carefully dried it must be treated with alcohol, which dissolves the 
emetia. The emetia obtained by the evaporation of the alcohol must 
then be dissolved in a dilute acid, and treated with pure animal char- 
coal. After this purification it must be precipitated by a salifiable base. 

Impure emetia is in the form of reddish brown, transparent scales 
which are almost inodorous, and of a bitter taste. It is very deliquescent, 
and soluble in water. Pure emetia has a white, and frequently some- 
what yellowish, appearance, is pulverulent, and does not deliquesce like 
the impure. It is but little soluble in cold water ; more so in warm. 
It dissolves readily in ether and alcohol. With acids it forms erystalli- 
zable compounds, from which it may be precipitated by galls, which 
are the best agents for obviating its effects in an overdose. 

Emetia — the impure especially — has been proposed as a substitute 
for ipecacuanha, and with this view formulae for officinal preparations 
of it have been received into many of the Pharmacopoeias of continental 
Europe. It would not seem, however, that much advantage would 
result from its use, and it certainly is far more expensive than ipecacu- 
anha in any of its forms of preparation. The dose of impure emetia is 
a grain or a grain and a half, given at intervals of fifteen or twenty 
minutes until it vomits; of pure emetia, from a quarter to half a grain. 

7. GILLE'NIA. 

Gillenia is the root of Gillenia trifoliata, Spircea trifoliata, Indian 
Physic, American Ipecacuanha, Beaumont Root; Sex. Syst. Ico- 
sandria Pentagynia; Nat. Ord. Rosacese ; — an indigenous herbaceous 
plant, which grows throughout the United States, to the east of the 
Alleghanies, from Florida to Canada, in light soils and in shady and 

Vol. I.— 9 



130 



moist situations : 



SPECIAL EMETICS. 



and flowers in June and July. The root is gathered 



in September. . . 

GilUnia stipula'cea grows in the valley of the Mississippi. 

is like that of the ea: 



Fig. 6. 




Gillenia stipulacea. 



Its root 
eastern spe- 
cies, and is said to possess the 
same properties. 

As met with in the shops, the 
root of Gillenia is of the size of 
a small goose-quill, wrinkled 
longitudinally, with occasional 
transverse fissures, and, in the 
thicker pieces, having a some- 
what knotty appearance, owing 
to indentations on one side cor- 
responding with prominences 
on the other. The chief pro- 
perties are in the cortical por- 
tion, which has a bitter disa- 
greeable taste. Its virtues are 
extracted by the same men- 
strua as ipecacuanha. 

As one of its names imports, 
its medical virtues resemble 
those of ipecacuanha, for which 
it is substituted by some. It is 
not, however, much used, al- 
though said to be a mild and 
satisfactory emetic. The dose 
of the powder is from 20 to 30 
grains, repeated, like ipecacu- 
anha, at intervals of 15 or 20 
minutes until it operates. 

8. SCILLA.— SQUILL. 

Squill is the bulb of Scilla or 
Squilla maritima. Sea onion; 
Sex. Syst. Hexandria Mono- 
gynia ; Nat. Ord. Liliacese ; 
which grows on the shores of 
the Mediterranean — viz. Spain, 
France, Italy, Sicily, Greece 
and Africa. It is imported, 



both in the fresh and dried state, but much more commonly in the latter ; 
owing perhaps to the fact that in England, and we believe in this 
country also, the duty on the dried bulb is no higher than that on the 
fresh. 

The fresh bulb is pear-shaped, and consists of concentric lamella?, 



SCILLA. 131 

the outer ones of which are thin, membranous, and of a brownish-red 
colour, whilst those within are whitish, thick, fleshy and juicy. 

In English pharmacy, two kinds of squill are met with, — the ichite 
and the red, the former of which is preferred. The average, weight of 
the bulb is from half a pound to four pounds, but it has been seen 
weighing ten pounds and a half. The fresh bulb is kept in dry sand ; 
and before drying it the dry rind is removed ; after which the bulb is 
cut transversely into thin slices, and dried as quickly as possible with a 
gentle heat. 

• Dried squill of the shops is in yellowish- white, or white, slightly 
diaphanous pieces, which are brittle when dry, but generally flexible, 
owing to their high hygrometric property ; on which account, it ought 
to be kept in a dry place, or in well stopped bottles. It is inodorous ; 
and of a bitter, nauseous, extremely acrid taste. It yields its virtues to 
water, alcohol and vinegar. Its best solvents are dilute alcohol and vine- 
gar, which are, consequently, used in various officinal formulae. 

Squill has been subjected to analysis by different chemists ; but the 
results have not been satisfactory, and it is not admitted, that the active 
principle has been isolated. 

In large doses, squill belongs to the acro-narcotic class of vegetable 
poisons. When given to a less extent, it operates as an emetic, gene- 
rally producing catharsis also. As an emetic, it is rarely prescribed, ex- 
cept in affections of the respiratory organs ; over which — as will be 
shown under the head of Expectorants — it is conceived to exert some 
special agency. It is rarely, however, given, except in croup, to such 
an extent as to produce emesis : it is exceedingly uncertain in its action, 
and the vomiting induced by it is, at times, of the most harsh and disa- 
greeable kind. 

The dose of powdered squill, as an emetic, is from six to twelve 
grains ; but it is scarcely ever prescribed in this form to the adult ; and 
to children one of the following preparations is selected. If it be de- 
sirable to nauseate by the powder, one or two grains may be given three 
or four times a day, gradually increasing the dose until the effect is 
induced. J, 

TINCTU'RA SWIM, TINCTURE OF SQUILL— (Sail. Z\v. ; Alcohol, dilut. 
Oij. Prepared either by maceration, or by the process of displacement.) 
As a nauseant, this tincture may be given in the dose of 30 or 40 drops, 
two or three times a day. It is rarely, however, prescribed with this 
view, being generally added to expectorant mixtures. It is not admin- 
istered as an emetic. 

ACE'TUl SCILLA, VINEGAR OF SQUILL.— (Skill cont. 3iv. ; Acet distillat. 
Oij. ; Alcohol, f. ^j. Prepared either by maceration or by the process 
of displacement.) Two fluidrachms will usually induce nausea. The 
alcohol is added to prevent decomposition. 

OX'YMEL SCILLE, OX'TMEL OF SQUILL.— (Mel. despumat. fgiij. ; Acet. 
Scillce, Oij. Reduce to the specific gravity 1.32.) This preparation is 



132 



SPECIAL EMETICS. 



Fig. 7. 



occasionally prescribed for children labouring under croup or pul- 
monary catarrh, and repeated so as to induce vomiting. The dose 
for this purpose is a tea-spoonful given every fifteen or twenty minutes. 

SYRU'PUS SCILM3, SYRUP OF Wmi.-(^cet. Scilla Oj. ; Sacchar. $ij.) 
Given as a nauseant and emetic in the same cases and doses as the last. 

SUtUOT SCILLA COMPOSITE, COMPOUND SYRUP OF SQUILL.— The Mel. 
Settles Compositum or Compound Honey of Squill of the former 

Pharmacopoeias of the United States. 
(Scill. cont. ; Senegce cont. aa 3iv. ; 
Antimon. et Potass. Tartrat. gr. xlviij.; 
JiqucB Oiv; Sacchar. fgiiiss. The 
water is poured upon the squill and 
senega. It is then boiled to one-half, 
and strained; the sugar is added, and 
the whole evaporated to three pints. 
Whilst hot, the tartrate of antimony 
and potassa is dissolved in it. It may 
also be prepared by the process of dis- 
placement.) This preparation is com- 
monly known under the name of Hive 
Syrup ; and as a formula of the kind 
was originally proposed by Prof. J. R. 
Coxe, it bears the name of Coxe's Hive 
Syrup. It is much used in domestic 
practice, and is a favourite remedy for 
croup and every form of pulmonary 
catarrh in children. The dose is from 
ten drops to a fluidrachm, according 
to the age of the child, repeated every 
fifteen or twenty minutes until it ope- 
rates. It is doubtful, however — as 
elsewhere remarked — whether this 
syrup have any virtues as an emetic 
not possessed by tartrate of antimony 
and potassa, or ipecacuanha; whilst it 
has the same inconveniences as the 
former — one grain being contained in 
an ounce of the syrup. " The Hive 
Syrup of Dr. Coxe," observes Dr. J. 
B. Beck — "which is now in every 
family, and is given on the slightest 
occasion to infants, without even consulting a physician, has, I am confi- 
dent, done a great deal of harm. I say this without wishing to under- 
value this preparation. In proper cases it is really a useful article, but 
persons out of the profession ought to know that its principal efficacy is 
owing to the quantity of tartar emetic which it contains, and that the 
indiscriminate use of it in cases where mild articles are required, must 
be injurious." 

The author has no partiality for it. 




Lobelia inflata. 



SINAPIS. 



133 



9. LOBE'LIA. 

Lobelia Inflata, Indian Tobacco or Emetic Weed ; Sex. Syst. Pentan- 
dria Monogynia : Nat. Order, Lobeliaceee ; is an indigenous plant, 
which is a common weed throughout the United States, beginning to 
flower about the end of July and terminating on the occurrence of frost. 
The plant is collected in August or September. When chewed, it pro- 
duces the same effects as tobacco. Like it, too, it appears to contain 
an essential oil on which its odour depends; and an acrid or alkaline 
principle, to which its effects on the system have been ascribed. To 
this acrid principle, Mr. Procter, of Philadelphia, who separated it, gave 
the name Lobelina, He found that the seeds contained at least twice 
as much in proportion as the whole plant, which yielded only one part 
in 500. 

Lobelia imparts its virtues to the same menstrua as ipecacuanha. It 
is a powerful acro-narcotic, and has, therefore, to be administered with 
caution. On this account it is not often given, in regular practice, as 
an emetic. The dose of the powder is from five grains to twenty, re- 
peated until it operates. 

TINCTITRA LOBE™, TINCTURE OF LOBE'LIA. (LobeL liv. ; Alcohol dilut. 
Oij. ; prepared either by maceration or by the process of displacement.) 
The full dose of the tincture, as an emetic, is about half a fluidounce ; 
but it is sometimes prescribed as an emetic and narcotic in asthmatic 
cases, in the dose of f.Jj- or f.3ij, until vomiting is induced. 



10. SINA'PIS.— MUSTARD. 

Mustard is the seed of Sinapis Fi s- 8 - 
nigra, and S. alba; Sex. Syst. 
Tetradynamia siliquosa : Nat. Ord. 
Cruciferse ; plants which are indi- 
genous in Europe, but cultivated 
there as well as in this country, and 
which flower in June. It is kept in 
the shops, both in seed, and in fine 
powder prepared on the large scale 
for culinary purposes. 

Black mustard seed are small and 
roundish ; of a reddish or blackish- 
brown colour externally, and yellow 
internally. When entire, they are 
inodorous; but when bruised, the 
odour is very pungent ; taste bit- 
terish and acrid. The seeds of 
white mustard are larger, and of a 
somewhat less pungent taste. Both 
varieties afford a yellow powder of 
a somewhat unctuous character. 

When bruised Or powdered, they SinapisAlba. Sinapia Nigra. 

communicate their active properties to water, but only slightly to alcohol. 




134 SPECIAL EMETICS. 

Both black and white mustard seeds have been repeatedly subjected 
to chemical analysis, and the results are interesting to the organic 
chemist, although very little so to the therapeutist. When black mustard 
seed are subjected to pressure, about 28 per cent, of fixed oil is obtained, 
which has a faint smell of mustard, and a mild oily taste, and which 
has been used as a cathartic and anthelmintic. On distillation with 
water, a volatile oil is obtained, which is exceedingly acrid, and con- 
tains a portion of sulphur. This oil, it appears, does not pre-exist in 
the seeds, but is produced by the action of water. 

White mustard seeds contain more fixed oil than black, but they 
cannot be made to yield any volatile oil. Their activity appears to be 
owing to a non-volatile acrid substance, which does not exist ready 
formed in the seeds, but is readily formed in them under certain condi- 
tions. It was affirmed many years ago, by MM. Trousseau and Blanc, 
that the irritating property of black mustard is diminished by the addi- 
tion of vinegar, which is very often used in forming sinapisms ; and that 
a mixture of concentrated acetic acid in certain proportions with black 
mustard powder is wholly inert, although either one or the other would 
act as a powerful excitant — if used, the former with water, the latter 
undiluted. The vinegar and acetic acid, in these cases, have the effect 
of preventing the development of the acrid volatile oil. 
. Some interesting experiments have been made on this subject, by two 
modern writers on therapeutics and materia medica, MM. Tro»sseau 
and Pidoux, who found : First. That there was no notable difference 
between mustard pounded eight days before it was used, and that which 
had been pounded five months before. Secondly. That a sinapism pre- 
pared with hot water acts more rapidly than one prepared with cold 
water ; but at the end of a few minutes this difference no longer exists. 
Thirdly. That mustard mixed with water acts with greater energy than 
that which is mixed with common vinegar, weak acetic acid, and con- 
centrated acetic acid ; and that, reciprocally, acetic acid, mixed with 
mustard, loses its activity. These gentlemen add, that the admixture 
with vinegar appeared to have no effect on English mustard — a discre- 
pancy which they express themselves unable to explain. It has been 
suggested, however, by Dr. Pereira, that this may perhaps be referable 
to the fact, that common English flour of mustard contains pod pepper, 
the active principle of which [capsicin) is soluble in vinegar. It does 
not appear that the same deteriorating influences are exerted on white 
mustard. 

The medical properties of mustard, are those of an acrid excitant. 
When it meets with water — as already remarked— volatile oil is deve- 
loped, which is the occasion of the acrid vapour, that arises when flour 
of mustard and hot water are mixed together. 

Mustard seeds bruised, or the powder, in the dose of a large tea- 
spoonful, will generally operate as an emetic, and have been esteemed 
useful, where it has been considered advisable to rouse the sensibility 
of the stomach, — as when narcotic poisons have been taken, in malig- 
nant cholera, and in certain forms of paralysis. The powder is more 
frequently, however, diffused in warm water, and administered to aid 
the operation of other emetics. 



TABACUM. 135 



11. TAB' ACUM.— -TOBACCO. 



The leaves of Nicotiana Tabacum. — Sex.Syst. Pentandria Mono- 
gynia ; Nat. Ord. Solanese or Solanacese — are the officinal portion of 
the plant so well known owing to its extensive cultivation in this coun- 
try, and to its employment in most parts of the globe. It imparts its 
properties to both water and alcohol; but long boiling •destroys them, 
and accordingly, the extract is devoid of all the virtues of the plant. 

Tobacco has been subjected to analysis by many chemists, the result 
of which would seem to show, that the two main active principles are — 
a peculiar oily-like alkaloid, called JVicoti'na, or Nico'tia ; and a cam- 
phoraceous volatile oil termed Nico'tianin, Concrete volatile oil of 
tobacco, and Tobacco camphor. Nicotia belongs to the same class of 
principles as conia, and closely resembles it in chemical properties. It 
appears to be the most active of the constituents. 

When tobacco is distilled at a higher temperature than that of boiling 
water, an empyreumatic oil is formed, under new T combinations, which 
is virulently poisonous. This oil is formed in the pipe of the smoker, 
and is associated with nicotia. 

In large doses, tobacco is one of the most violent acro-narcotic 
poisons. In smaller doses, it occasions vomiting accompanied by the 
most deadly sickness and sedation. Hence, its use in cases where 
great relaxation is necessary. Its powerful nauseant and emetic opera- 
tion, as well as its effect on the nervous system, is well seen in those 
who attempt to chew or to smoke it for the first time. Even when 
given in glyster, or applied to abraded surfaces, it has caused death ; 
and a tobacco cataplasm applied to the pit of the stomach has succeeded 
in inducing nausea and vomiting, more especially where other emetics 
have been taken previously. As a nauseant, and therefore relaxant, it 
has been employed in various forms of colic, constipation and strangu 
lated hernia ; and its operation is generally attended with nausea and 
giddiness. In these cases, it is thrown into the rectum either in the 
form of infusion, or of smoke ; and in strangulated hernia especially, it 
has proved effective, after blood-letting, tartrate of antimony and potassa, 
and other sedative relaxants had been used in vain. In like manner it 
has been prescribed in retention of urine, tetanus and other spasmodic 
diseases, — wherever, in short, it is important to produce powerful seda- 
tion, or to relax spasm. Still, the fatal results, occasionally superven- 
ing on its employment, must be borne in mind, and it must not be used 
except in cases which have resisted other means. This is probably the 
cause, why both the physician and the surgeon prescribe it rarely. 

Tobacco has been given as an emetic, in the form of snuff", — five or 
six grains constituting a sufficient dose ; but it is rarely prescribed in 
this shape. 

IPU'SUM TAB'ACI, INFU'SION OF TOBACCO.— (Tabac. 3j. ; Jquce bullient. 
Oj.) This is never used except as an enema to produce relaxation. It 
is safer to inject only one half ; and if the relaxant effects be not in- 
duced in half an hour, to throw up the remainder. It must be borne in 
mind, that a smaller quantity than half a drachm has proved fatal. 



136 



SPECIAL EMETICS. 



Fig. 10. 



VMM TAB'ACI, WOE OF TOBACCO.— ( Tabac. concis. Ij. ; Vim. Oj.) 
This preparation has been more frequently employed as a diuretic, but 

it is capable, in repeated doses of 
thirty or forty drops each, of in- 
ducing nausea. A cataplasm is 
sometimes made of common snufl 
and cerate, and has been applied 
to the throat and breast in cases 
of croup ; and Dr. Wood states, 
that one of the worst cases of 
spasm of the rima glottidis which 
he had seen, and which had re- 
sisted powerful depletion by the 
lancet, yielded to the application 
of a tobacco cataplasm to the 
throat. 

The infusion of tobacco has, 
likewise, been employed with ad- 
vantage, as a bath, in tetanic and 
similar neuropathic affections; — 
and the cigar has been used, with 
advantage, in the same cases by 
those who have been unaccus- 
tomed to it. 

12. SANGUINA'RIA.— BLOODROOT. 

• 

Sanguinaria is the root of San- 
guinaria Canadensis, Blood-root, 
Puccoon, Indian Paint, Turme- 
ric ; Sex. Syst. Polyandria Mo- 
nogynia ; Nat. Ord. Papave- 
raceae ; an herbaceous perennial 
plant, which flowers early in 
spring, and grows abundantly in 
every part of the United States. 
The root, which is the only offi- 
sanguinaria canadensis. c i na i portion, when dried is in 

flattened pieces, much wrinkled and contorted. The fracture is spongy 
and uneven,— its surface being at first bright orange, but becoming, by 
exposure, of a dull brown colour. It has a bitterish acrid taste, and 
imparts its virtues to water and alcohol. An active principle— Sangui- 
narine— has been obtained from it, which is alkaline, and considered to 
possess all the virtues of the root. 

It is said to lose its virtues rapidly by keeping. 

Bloodroot is an acrid emetic ; and, in large doses, belongs to the 
class of acro-narcotic poisons. It is not often employed as an emetic. 
The dose of the powder, with this view, is from ten to twenty grains. 
It is recommended, that it should be taken in pill by preference in con- 
sequence of the great irritation of the throat produced by the powder 




ANTHEMIS. 



137 



Fig. 11. 



when swallowed. (Wood and Bache.) It may also be prescribed in 
infusion ; (Sanguinarice 3ss ; Aq. fervent. Oj.) of which the dose may 
be a table-spoonful or two. 

TINCTU'RA SANGUINA'RIl, TINCTURE OF BL00JJR00T; — (Sanguinar. cont. 
Jiv: Alcohol, dilut. Oij. Prepared by maceration or by the'process of 
displacement.) The dose, as an emetic, is f.3iij. to f.3iv., but it is 
not often administered as such. 

13. ANTHEMIS.— CHAMOMILE. 

Chamomile is the flower of Amlhemis nobilis ; Sex. Syst. Syngene- 
sia Polygamia Superflua ; Nat. Ord. Compositae Corymbiferee, a plant 
which is indigenous almost every 
where in temperate Europe. The 
flowers become double by culti- 
vation ; and hence those which 
are found in the shops, and which 
are imported from Germany and 
England, are of this character. 
It is cultivated largely around Lon- 
don for the market of that city. 

The odour of chamomile is' 
powerful, fragrant and grateful ; 
and the taste warm and bitter. 
It imparts its virtues to both water 
and alcohol, the former of which, 
at the boiling temperature, ex- 
tracts nearly one-fourth of its 
weight. Its most important con- 
stituents are, — volatile oil, bitter 
extractive and tannic acid ; and 
as the excitant properties are 
greatly dependent upon the first 
of these, decoction is an objec- 
tionable form, where it is desira- Anlhemis Nobilis 
ble to have a preparation contain- 
ing all the virtues of the drug. 

With the view of producing emesis, but one preparation of chamo- 
mile is ever given, — the tepid infusion ; and it is rarely prescribed 
except with the view of aiding the action of other emetics, or in cases 
where there is a disposition in the stomach to relieve itself sponta- 
neously. 

INFU'SIM AITHEM'IDIS, INFU'SION OF CHAMOMILE, {Mhemid. Iss. ; Aqua 
bullient. Oj. Dose, as an emetic, f.giv. The infusion— Chamomile 
tea — is generally, however, made extemporaneously in domestic prac- 
tice. 




138 



SPECIAL EMETICS. 



Fig. 12. 




Apocynum Androsaemifolium. 
• Fig. 13. 



14 SO'DTI CHLCVRIDUM.— 
CHLORIDE OF SO'DIUM. 

When common salt — 
whose properties are de- 
scribed under Cathar- 
tics — is taken in the dose 
of a table-spoonful or 
more, it excites vomiting ; 
and during the visitations 
of epidemic cholera, it 
was preferred by some 
practitioners to other eme- 
tics. It has also been 
given in cases of narcotic 
poisoning, where neither 
the stomach-pump nor an 
emetic was at hand. 




Phytolacca Decandra. 



A few other indigenous 
substances that act as 
emetics have been admit- 
ted into the secondary list 
of the Pharmacopoeia of 
the United States, viz : 

15. Apoc"ynum An- 

DROSiEMIFo'LIUM, DogS- 

bane ; Sex. Syst. Pen- 
tandria Digynia ; Nat. 
Ord. Apocynaceae ; a 
plant which nourishes 
in every part of the 
Union, flowering in 
June and July, and is 
emetic in the dose of 
thirty grains of the 
dried root. 

16. Ascle'pias In- 
carna'ta, Flesh colour- 
ed Ascle'pias ; Sex. 
Syst. Pentandria Digy- 
nia ; Nat. Ord. Ascle- 
piadaceaB ; flowering 
from June to August. 
The root has been used 
as an emetic and ca- 
thartic. 

17. Erythro'nium, 



PHYTOLACCA RADIX. 



139 



Dog's Tooth Violet ; Sex. ' 
Syst. Hexandria Mono- 
gynia ; Nat. Ord. Li- 
liaceae ; which grows 
throughout the Northern 
and Middle states ; flow- 
ering in April and May; 
the root and herb being 
officinal. Dose, as an 
emetic, twenty or thirty 
grains of the recent bulb. 

'18. Euphor'bia Co- 
roll a'ta, Blooming or 
Large flowering Spurge, 
Milk weed; Sex. Syst. 
Dodecandria Trigy'nia ; 
Nat. Ord. Euphorbia- 
cese ; which grows in va- 
rious parts of the United 
States, flowering in July 
and August ; the dried 
root of which is emetic in 
the dose of from ten to 
fifteen grains. 

19. Euphor'bia Ipe- 
cacuan'ha, Ipecacuanha 
Spurge, American Ipe- 
cacuanha, which flourishes 
in the Middle and South- 
ern states, blooming from 
May to August ; the dried 
root of which is emetic in 
the dose of from ten to fifteen grains. 



Fig. 14. 




Erythronium Americanum. 



20. Phytolacca Radix, Poke root — the root of Phytolacca Decan- 
dra ; Sex. Syst. Decandria Decagynia ; Nat? Ord. Phytolacca? ; which' 
is emetic in the dose of from ten to thirty grains ; but is slow and pro- 
tracted in its operation, apt to act upon the bowels, and in very large 
doses to induce symptoms of acro-narcosis. It is not, therefore, often 
used. 



140 CATHARTICS. 

II. CATHARTICS. 

Synon. Dejectoria, Eccathartica, Hypactica, Lapactica, Apocathartica, Coprocritica. 

Definition of cathartics— Effects they are capable of inducing— Organs on which they act 
— Divided into laxatives and purgatives — Drastics — Abuse of cathartics — Glysters — Sup- 
positories — Therapeutical application — In fevers— In inflammatory disorders— In hemor- 
rhage — In the neuroses — In dropsies, &c. Special cathartics. 

The simplest definition of cathartics is— " agents that increase the 
number of alvine evacuations." Certain writers on Therapeutics have 
endeavoured to incorporate in the definition their modus operandi ; and, 
in a modern work, the definition is still farther, and with less propriety, 
extended, so as to include other effects which they may or may not 
induce. Thus, the Messrs. Schroff define them to be ; — " Medicines, 
which, by augmenting the secretion and peristole of the intestinal tube, 
occasion the evacuation by the anus of accumulated and noxious mat- 
ters:" but it is obviously not necessary for the induction of catharsis, 
that there should be any accumulation, healthy, morbid, or noxious, in 
the bowels. 

There is no class of medicinal agents possessed of more valuable 
properties; and none more abused. Exposed, as the digestive organs 
are, to the most heterogeneous and often irritating substances, and liable 
to have their tone injured by alternations of stimulation and depression, 
accumulations of food as well as of secretions are apt to occur, which 
demand the use of cathartics, the effect of which is not confined to the 
mucous membrane of the alimentary tube, but through the nerves, is 
propagated elsewhere, so as to react on organs situate at a distance 
from the seat of the impression. 

To fully comprehend the effects that cathartics are capable of indu- 
cing, it may be well to consider briefly the organs and tissues on which 
their operation is immediately exerted. 

The mucous coat of the small and large intestines is an extension of 
that of the stomach, and, with some modification, of that of the supra- 
diaphragmatic portion of the digestive tube ; whilst this, again, may be 
looked upon as an extension of the general cutaneous envelope. Like 
the mucous lining of the stomach, that of the small intestines is a part 
of the surface of relation ; and impressions made upon it are probably 
conveyed, with equal facility, to the great nervous centres. Hence it is, 
that it has been regarded by M. Broussais as the seat of many important 
diseases, of a febrile character especially. 

In the mucous coat are situate many of those mucous glands or folli- 
cles, which, in consequence of their having been described by Brunner, 
Lieberkuhn, and Peyer, have been called after those observers. The 
function of the first two is to secrete mucus for lubricating the mucous 
membrane ; but, of late, the importance of Peyer's glands, more espe- 
cially, in the economy has perhaps been exaggerated ; and, as has been 
previously remarked, they have been looked upon as the seat of many of 
those ataxic and adynamic fevers, which M. Broussais referred to the gas- 
troenteric mucous membrane generally. It does not appear probable, 



CATHARTICS. 141 

that these small bodies can be so intimately associated, in their morbid 
derangements, with the great vital organs, as to give occasion to the 
diseases, that have been ascribed to them. Their function seems to be 
to secrete matter having the faecal odour — perhaps putrescent materials 
from the blood, but they have not perhaps any great agency in the causa- 
tion of disease. Frequently, on dissection, they are found considerably 
enlarged ; and this, doubtless, owing, at times, to their forming part of 
the lining of the tube, as M. Broussais suggested. At other times, they 
are enlarged and ulcerated, and thus become one of the expressions of 
typhoid fever, but not the essence of it; as the eruption of- measles or 
scarlatina is only one of the expressions or manifestations of those 
diseases. 

The mucous membrane, besides the secretion from the follicles, 
exhales the ordinary halitus of the mucous membranes, and the two 
together are to a considerable amount. The daily quantity of the liquor 
entericus or succus intestinalis, as it has been called, was estimated by 
Haller at probably far beyond the truth. 

In addition to this humour, the upper part of the small intestine 
receives the secretions from two important organs, — which, from their 
presumed agency in chylosis, have been termed assistant chylopoietic 
viscera, — the liver, and the pancreas, whose ducts open together. 

From the upper portion of the small intestine more especially, the 
chyliferous vessels arise : — this part of the tube must, therefore, be 
regarded as the great seat of chylosis or chylification. 

It is not until the faeces have attained the lower part of the small 
intestine, or the commencement of the large, that they attain the full 
faecal odour. This is not produced altogether by the reaction of the 
elements of the food upon each other, but by a peculiar secretion, in 
part, perhaps, from the glands of Peyer ; so that alvine discharges, 
possessed of the faecal odour, may take place, even when little or no 
food has been taken ; and, in the course of febrile affections, it becomes 
important to remove those, should constipation arise, as they are capable 
of inducing as much irritation as if they were the results of the diges- 
tion of alimentary matters. As long as life persists, secretions are 
poured into the alimentary tube throughout its whole extent from the 
lining membrane, as well as from the liver and pancreas ; and if these 
are permitted to remain in the canal, they become the source of irrita- 
tion, and mischief. The argument, often urged, — that it is not necessary 
for the bowels to be kept open in morbid cases, because no food has 
been taken, — is, therefore, fallacious. 

Although in the upper portion of the small intestines an arrangement 
of the mucous coat exists, — valvulae conniventes — calculated to detain 
somewhat the aliment in its course downwards, and to extend the sur- 
face for the origin of chyliferous vessels, in no part of its extent does 
it present the character of a reservoir. The opposite to this is the case 
with the large intestine. Its saccated arrangement clearly shows it to 
be destined for the detention of the faecal matters, until they have accu- 
mulated to such an extent as to give rise to a necessity for the act of 
defecation. In these saccated portions, the faeces are occasionally 
retarded, become indurated, and adhere to the mucous membrane, so 



142 CATHARTICS. 

as to excite irritation ; and, when evacuated, they are in the form of 
small rounded masses, to which the name scybala has been given. 

The whole of the intestinal canal is more or less endowed with the 
vermicular, oscillatory motion, which has been called peristole or peris- 
taltic action. This motion is under the influence of the ganglionic 
nerves, through which the muscular coat of the tube is excited to con- 
traction, and the degree in which contraction occurs is greatly connected 
with the mode in which the function of digestion is accomplished. 

Lastly, it is important to keep in view, that various organs are con- 
tinuous to the alimentary tube, whose functions are susceptible of modi- 
fication by agents that affect it. Reference has already been made to 
the liver, and pancreas ; and it will be found, that the uterus can, in this 
way, be considerably modified in its actions. 

As regards the effect of a cathartic on the intestinal canal much dif- 
ference exists according to the nature of the agent, and the dose in 
which it is exhibited. 

When the lining membrane is but slightly stimulated, chylosis may 
be augmented, and a laxative tendency be induced ; if it be more sti- 
mulated, the exhalation from it may be increased, and the irritation be 
extended by the sympathy of contiguity to the muscular coat, so that 
there may be a slight increase in the peristole ; and if the specific 
stimulation be still greater, both the exhalation and the peristole may 
be largely augmented. 

The effect of a mild cathartic may be almost wholly restricted to the 
evacuation of the tube ; and but little effect be exerted on other organs, 
or on the general system. The first evacuations, that result from its 
operation, consist merely of the contents of the intestines : those that 
follow are mixed with the secretions of the canal, and of the liver and 
pancreas, with the drinks that have been taken ; and at times, fluids — 
as soups — may be readily detected in the discharges. Yet, as the ap- 
pearance of an unusual quantity of bile in the matters ejected by 
vomiting may merely be an evidence that the excitement accompanying 
emesis has caused a greater secretion of bile, so — it must be borne in 
mind — the alvine discharges may assume an unhealthy bilious charac- 
ter under the operation of a cathartic, owing solely to the irritation it 
induces in the various secretory organs of the digestive apparatus. 
When the mild chloride of mercury, or the Pilula Hydrargyri, for ex- 
ample, is administered as a cathartic, it excites the lining membrane of 
the duodenum, and this irritation extends along the biliary ducts to the 
liver, the secretion from which is augmented. At the same time, it irri- 
tates the different follicles of the canal, and the exhalants generally, so 
that evacuations are occasionally induced by it, which resemble chopped 
spinach ; and which are regarded, by some, as indicating that it has 
succeeded in inducing a new action in the mucous lining of the tube. 
It can, hence, be understood, that after the operation of calomel, or of 
any purgative, whose action is chiefly exerted on the upper portion of 
the intestines, there maybe a greater quantity of bile in the evacuations, 
without our being justified in inferring, that the individual is bilious; 
— and, that the increased flow of bile is occasioned by the purgative 



GENERAL EFFECTS. 143 

may be proved by discontinuing its use for some days, when the signs 
of bile in the evacuations will cease, and be reproduced when it is 
resumed. 

It has been mentioned, that the mild chloride of mercury and the 
V blue pill" affect the upper part of the intestinal canal ; and the same 
may be said of rhubarb, colocynth, &c. There is, indeed, a singular 
preference on the part of different cathartics for different portions of the 
tube ; some, — as the articles enumerated, — acting on the upper part ; 
others, as aloes, on the large intestines, and especially on the colon and 
rectum ; and others, as the saline and oily, affecting the whole tract of 
the intestines. Accordingly, a selection may be made so as to suit the 
particular view of the practitioner. At times, too, it is desirable to act 
on other organs through the intestinal canal, by means of sympathy ; as 
when we wish to affect the liver or pancreas, — in which case cathartics 
are chosen, that act on the part of the tube into which the ducts of those 
glands enter, — or the uterus, when one is selected that acts by preference 
on the lower portion of the tube, and affects the uterus by sympathy of 
contiguity. It is in this way, indeed, that aloes has acquired its reputa- 
tion as an emmenagogue. 

Cathartics act not only on the bowels but on parts at a distance. Every 
portion of the organism is capable of being impressed by them. They 
are amongst the most generally useful, and applicable revellents that we 
possess ; and, when given to such an extent as to cause hypercatharsis, 
they rapidly reduce the powers of the system, — less, perhaps, by the 
copious exhalation of the serous portions of the blood, which they cause 
from the lining, membrane of the intestines, than by the sympathy that 
exists between them and the vital organs. Reference has been made 
more than once to the destructive influence exerted on those organs by 
irritation — often unmarked by prominent symptoms — in the intestinal 
tube. It is by their mixed depletive and revulsive action that they be- 
come useful sorbefacients in hydropic affections, and cases of rapid 
disappearance of dropsical effusions under their operation are often wit- 
nessed. 

Cathartics differ greatly from each other in their mode of operating. 
Some gripe much ; others not at all. Some operate many times ; others 
rarely more than once ; although much, in this respect, depends upon 
the individual. Pharmacologists have generally divided them, — accord- 
ing to the intensity of their operation, — into laxatives, purgatives, and 
drastics, under which all the articles may be arranged. To these may 
be appended another division — that of enemata. The ancient humo- 
rists, who considered, that most diseases are produced by the predomi- 
nance of spme particular humour, which needs evacuation, and that 
particular cathartics are eminently endowed with the power of fulfilling 
these objects, divided them into hydragogues, phlegmagogues, chola- 
gogues, and pantagogues or panchymagogues, according as their operation 
was exerted more especially upon the watery portions of the blood, on 
phlegm, bile, or on all the secretions from the tube. 

The division of cathartics into laxatives and purgatives is convenient, 
and not inappropriate. Laxatives gently stimulate the mucous coat of 
the intestines, and augment the peristole but little : hence, they are well 



144 CATHARTICS. 

adapted for cases in which the sole indication is to unload the bowels 
of their contents. Some of them produce their effects entirely in a 
mechanical manner. Corn bread, for example, proves laxative, in con- 
sequence of the mechanical attrition of the particles of husk left mixed 
with it on the mucous membrane. In the same manner, bread made of 
unbolted flour is laxative, and becomes proper, in the way of diet, when 
there is torpor of the digestive function ; for which reason it has attained 
the name " dyspeptic bread." Other laxatives, again, are special local 
stimulants, or affect the mucous membrane by their medicinal properties, 
— as sulphur, magnesia, &c. These, when given in a much larger dose 
than usual, may still be merely laxative. They do not induce full 
catharsis ; and are, therefore, separable, with propriety, from the 
division of purgatives, many of which cannot, in the most minute doses 
be made to act as laxatives. 

Purgatives produce their effects like laxatives, but their operation is 
more powerful. They excite a copious exhalation from the mucous 
lining of the intestines, and augment the peristaltic action to a greater 
degree. It is in consequence of the evacuation of watery matters, pro- 
duced by the operation of purgatives, that they are used as depletives 
in febrile, and inflammatory affections ; and, from the excitation they 
occasion in the abdominal nerves, they are energetic revellents. This 
excitation is often shown in the tormina and irritation that precede and 
accompany their operation. 

The more violent purgatives have been termed drastics. They pro- 
duce a greater degree of irritation in the lining membrane of the 
intestines, and occasionally act upon the nerves of the stomach so as to 
induce nausea, and even vomiting. They belong generally to the resi- 
nous or resino-extractive substances ; and one reason, why they excite 
such violent tormina, appears to be, that they are sparingly soluble, and 
adhere to the mucous coat, from which they are tardily detached. This 
view is corroborated by the circumstance, that if we add any substance 
to them, that aids their solubility, the griping may generally be prevented, 
or considerably mitigated. 

After all, however, the division of cathartics into laxatives and pur- 
gatives, although generally convenient, and not inappropriate, is not 
always so. Much depends upon the individual, so that a laxative may 
purge drastically, whilst a drastic may scarcely purge at all. Still, these 
are exceptions. 

Cathartics usually produce their full effect without being absorbed : 
they are altogether local stimulants to the mucous membrane of the in- 
testines, and through it to the muscular coat. Yet, they can act by the 
way of the circulation, and the fact is another instance of t^e singular 
preference, exerted by medicinal agents for certain parts of the organ- 
ism rather than for others. When a respectable physician, Dr. Hale, 
of Boston, injected castor oil into his veins, he speedily felt an oily taste 
in his mouth, which continued for a length of time, and the medicine 
produced much intestinal disturbance. Croton oil, when placed on the 
tongue of an apoplectic, in whom deglutition is impracticable, causes 
its ordinary cathartic operation. Rhubarb exerts the same agency when 
applied to the skin ; and the milk of a wet-nurse, who has taken infusion 



GENERAL EFFECTS. , 145 

of senna, rhubarb or other cathartics, may act upon the intestinal canal 
of the child. 

As a general rule, the action of cathartics is in a direct ratio with the 
dose — within certain limits. Some, however, are so potent, that it is 
almost impracticable to reduce them to the point at which they are 
simple laxatives. Elaterium is one of these. On the other hand, there 
are agents, whose operation is altogether so gentle that if given to any 
amount, they will not be drastics. Such is the case with manna, mag- 
nesia, sugar, and olive oil. Their operation is always that of gentle 
cathartics or laxatives. There are substances, again, of this class, whose 
operation in a full dose is more violent than that which is considered to 
characterize the action of laxatives ; and which, when given in much 
larger quantity, exert no more energy. Such is the general fact with 
calomel, castor oil, and rhubarb. The effect of these cathartics is com- 
monly, indeed, but little appreciated, or, if appreciated, but little 
attended to. A tea-spoonful or two of castor oil is often sufficient to 
evacuate the bowels, not only in health, but in chronic febrile and other 
affections, — where the object is simply to produce such evacuation. 
Exceptions, indeed, occur to this, but the rule is not the less general ; 
and it is important to. bear it in mind, inasmuch as the stomach is often 
extremely irritable, and but little adapted, in those affections, for the 
reception of a large amount of indigestible oleaginous matter. Given 
in these small doses, it is one of the best cathartics we possess for keep- 
ing the alimentary canal clear, when there is irritation of the gastro- 
enteric mucous membrane, as in gastric and other fevers. It has been 
maintained, indeed, by Rasori and others, that the action of all cathar- 
tics increases in a direct ratio with the dose within certain limits only, 
and that beyond these, the opposite is the fact, — the evacuant power 
being, in other words, directly as the dose up to a certain point, and 
inversely as the dose beyond that point ; — that in the latter case they 
may act as sedatives without producing any cathartic effect whatever ; 
and that, consequently, most purgative medicines may be considered not 
only as simple evacuants, but as antiphlogistics or sedatives. To this 
subject, however, reference will have to be made under the individual 
articles of the class, and especially under Calomel, where the difference 
of action according to the dose is more strongly marked perhaps than 
in the case of any other cathartic. 

Substances, when largely divided, so that fresh and fresh portions 
come into contact with the lining membrane of the digestive tube, gene- 
rally act with more efficiency, than when they are given in such form, 
that the cathartic touches in bulk the surface on which it has to operate. 
Thus, an ounce of the sulphate of magnesia, dissolved in half a pint of 
water, and taken by tea-spoonfuls, at short intervals, will induce a 
greater action than if the whole solution were swallowed at once. This 
fact is elucidated by a case, which the late Dr. James Gregory, of Edin- 
burgh, was in the habit of relating in his lectures. A boy was directed 
to take an ounce of Epsom salts, but having a strong objection to the 
taste of the cathartic, he resolved to form it into pills with crumb of 
bread. On making the pills of an appropriate size, he found they 
amounted to three hundred and sixty, a number so near to that of the 

Vol. I.— 10 



146 CATHARTICS. 

days of the year, that he determined to make it correspond entirely. 
Accordingly, he divided them into three hundred and sixty-five portions, 
and took them all, one after the other. The effect was extraordinary. 
The most violent hypercatharsis was induced so as to endanger his life. 
This was owing probably to the gradual and successive breaking down 
of the pills in the stomach, so that particle after particle came in contact 
with the mucous membrane. ' • 

We can thus understand, that a saline cathartic, dissolved in a large 
quantity of water, may act more powerfully than if the quantity of the 
solvent were less. In many of the saline mineral waters, which are 
employed as cathartics, the quantity of saline ingredients is extremely 
small. A pint of Seltzer water is found to contain but five grains of 
carbonate of magnesia, and seventeen of chloride of sodium. , The same 
measure of Spa water contains nine and a half grains of carbonate of 
magnesia, and one quarter of a grain of chloride of sodium. The Aix- 
la-Chapelle water has five grains of chloride of sodium to the pint; the 
Balston, five grains of carbonate of magnesia, and eighteen of chloride 
of sodium ; the Bedford, a grain and a half of chloride of sodium, and 
ten grains of sulphate of magnesia ; and the Congress spring at Sara- 
toga, twelve grains of carbonate of magnesia, and forty-eight grains of 
chloride of sodium. These facts are not favourable to the cathartic 
effect of such agents being owing to simple endosmotic action; for M. 
Poiseuille found — as elsewhere remarked — that very concentrated solu- 
tions generally cause endosmose of the serum of the blood, whilst 
djlute solutions have a reverse effect, and give rise to endosmose of the 
solution. Now, substances, which, when introduced into the intestinal 
tube, produce endosmose of the serum, as concentrated saline solutions, 
solutions of cathartic extracts, &c, act as cathartics, whilst weaker 
solutions of the same substances may pass into the blood and rather 
excite diuresis. 

Many of the resinous purgatives cause much griping during their 
action, — apparently — as observed above — by adhering to the mucous 
lining, and acting as violent irritants ; hence * corrigents' are required 
to remove the disagreeable accompaniments of their ordinary operation. 
These may consist, either of substances, which add to their solubility ; 
of agents, which, by augmenting the peristole of the canal, hurry on the 
cathartic, so that it does not remain, for any length of time, in contact 
with any one portion of the mucous membrane ; or of such as shield the 
intestinal canal against its irritating influence. 

As a general rule, the solubh cathartics act more speedily than others ; 
yet the cathartic oils are exceptions to this; for they are scarcely, or not 
at all, soluble,— undergoing little or no change in the stomach. Castor 
oil becomes mixed with the various secretions and substances in the 
alimentary canal, and is divided into small filaments, so as occasionally 
to deceive the practitioner. Some years ago, J. P. Frank was requested 
to see a prince, who had been attacked with epilepsy. His physician, 
a respectable old practitioner, assured Frank, that he could at pleasure 
make his patient void thousands of filiform worms. As he was neither 
able to define the genus, nor species of these worms, the quantity of 
which, from his account, was prodigious, Frank requested to be a wit- 
ness of the phenomenon. The physician administered a dose of castor 



MODUS OPERANDI. 147 

oil, which produced several evacuations, in which were thousands of 
whitish filaments resembling small eels ; but on an attentive examina- 
tion, these supposed worms were found to consist entirely of castor oil, 
divided in the manner above mentioned. 

Owing to the fact, that — as a^ general rule — soluble cathartics act 
sooner than those that are less so, we can understand, that mixtures 
may operate more speedily than pills ; that saline cathartics may act 
more freely if we allow liquids to be taken during their operation ; and 
that resinous cathartics may be longer in operating than the saline. It 
has been attempted — but not with complete success — to show, that dif- 
ference of solubility may account for certain purgatives acting more 
upon one part of the intestinal canal ihan upon another. 

When demulcents are given along with acrid purgatives, they mode- 
rate the violence of their action, by shielding the mucous surface, so as 
to diminish the amount of local stimulation. In the same way, narcotics 
lessen the impressibility of the nervous system, and thereby diminish 
the operation of cathartics ; but if much spasm exist in the intestinal 
canal, they may aid their operation. Suppose, for example, a state of 
constipation, accompanied with violent colic, but without enteric in- 
flammation ; the combination of a full dose of an opiate with a cathartic 
will allay the spasm, and facilitate the action of the latter. Indeed, 
where enteric inflammation actually exists — especially if copious blood- 
letting has been premised — ^such a union of sedative and cathartic is 
often followed by the most beneficial results. The different varieties of 
colic are treated almost wholly, by many intelligent practitioners, by a 
combination of calomel and opium. 

If the desire be simply to evacuate the bowels, without heeding the 
revulsion which cathartics are capable of inducing, the rapid purgatives 
and forms of administration are to be chosen ; — such as castor oil, and 
the various saline substances ; but where habitual constipation exists, it 
is not always advisable to administer these agents in such doses as to 
act violently. A cathartic removes the contents of the canal, but it 
does not obviate the pathological condition, that gives rise to the con- 
stipation. On the contrary, in accordance with the laws of compensa- 
tion, which prevail so extensively in the animal economy, it is found, 
that the tendency to constipation is augmented after its operation, — 
diminished action of the exhalants of the mucous membrane, and of the 
muscular coat succeeding to the exaltation of the vital manifestations 
produced by the operation of the cathartic : hence, if active cathartics 
be had .recourse to in habits disposed to constipation, whenever this 
state exists, the person, in time, demands so imperiously the stimulation 
they excite, that he is unable to have an evacuation without them. This 
result is more liable to supervene after the action of certain purgatives 
than of others. Castor oil, and croton oil are more exempt from it than 
other cathartics, whilst rhubarb is generally esteemed more obnoxious 
to the remark than any of the class. 

The best mode of obviating this tendency to constipation is to avoid 
the exhibition of cathartics, that powerfully excite the organs directly 
and indirectly concerned in defecation, and to trust altogether to the 
employment of laxatives, and an appropriate regimen. The best laxa- 



148 CATHARTICS. 

tives, for such purpose, are those that affect the whole extent of the 
canal, and possess the property of developing its impressibility fcuch, 
it has been seen, is the operation of saline cathartics. A good prepa- 
ration of this kind is a mixture, formed by pouring a quart ot boiling 
water on an ounce of sulphate of magnesia, and one drachm of bitartrate 
of potassa, and directing the patient to take a wine-glassful of the solu- 
tion every night and morning, until the bowels are made to respond 
properly. The bitartrate of potassa is laxative, and its acid character 
masks the disagreeable taste of the sulphate of magnesia. The com- 
bination rarely fails to restore the intestinal functions to their due con- 
dition; but it is occasionally necessary to persevere in its use for some 
weeks before the full beneficial results are obtained. The author has 
had the most ample opportunity for witnessing the good effects of this 
compound. 

It is easy to conceive, that cathartics, which simply evacuate the 
contents of the bowels, may be more demanded in warm climates and 
seasons than in cold, in consequence of the erethism of the mucous 
membrane of the alimentary tube, which is developed during great 
atmospheric heat ; yet, owing to this very erethism, as well as to the 
greater degree of sensibility of the nervous system, generally induced by 
the same atmospheric condition, drastic cathartics may have to be used 
with more caution. 

The abuse of purgatives, like that of emetics, occasions great exalta- 
tion of the sensibility of the digestive tube. Broussais observes, in the 
commentary to his 155th proposition, that he had frequent opportunities 
for witnessing this effect in persons, who had taken the purgative of Le 
Roy, in the manner directed by that empiric, — that is, for several days 
in succession. So much irritability of the digestive apparatus was 
caused, that it was impossible to restore the equilibrium of action. At 
the present day, such abuse is by no means as common as it was half 
a century ago"; the impropriety of keeping up perpetual irritation in the 
lining membrane of the intestines in diseases, often themselves arising 
from irritation in this very membrane, having become appreciated. It 
need hardly be added, that whenever such irritation or active inflamma- 
tion is shown to exist, the operation of drastic cathartics, or of ordinary 
purgatives, is contra-indicated, although it may still be important to 
preserve the tube free from morbid secretions — which cannot fail to be 
thrown out in' such a state of the membrane — as well as from extraneous 
matters taken as aliment, which, under febrile heat, are more likely to 
undergo morbific changes. 

During gestation, as well as menstruation, violent cathartics must be 
prescribed with caution ; and those, whose action is exerted by prefer- 
ence on the lower part of the intestinal canal, should — as a general rule 
— be avoided. For this reason purgatives of the aloetic kind are not 
given, unless their operation is tempered by the addition of some sub- 
stance, as soap, which, by adding to their solubility, diffuses their action 
over a larger surface of the alimentary canal ; or, by the addition of 
a narcotic, as hyoscyamus, which renders their operation less irritating. 
Many of the abortives, employed with a criminal intent, belong to the 



GENERAL EFFECTS. 149 

class of cathartics, — their primary operation being on the intestinal 
canal, and the uterus becoming affected by contiguous sympathy. 

A selection of cathartics may be made, to a certain extent, to suit the 
age of the individual. In very young infants, the milder cathartics are 
employed, — as castor oil, magnesia, or rhubarb — combined, or not, 
with magnesia. Generally, during early childhood, there is a great pre- 
dominance of acidity, so that absorbent laxatives are especially indi- 
cated ; hence it is, that magnesia is in such common use. Calomel is 
also much given during the first periods of life, owing to the facility 
with which it can be administered. In old age, the warmer resinous 
cathartics are usually. employed, and these are generally given in the 
form of pill. 

In referring to the influence of the moral over the physique, it was 
remarked, that under particular emotions certain of the excretory func- 
tions are acted upon, and, amongst them, those concerned in defecation. 
Anxious dread, or excessive fear has this effect in a marked manner ; 
and it has been probably experienced by every one under such circum- 
stances. Certain emotions may, therefore, be looked upon as mental 
cathartics, although, as such, not capable of being employed in the 
treatment of disease. 

In the administration of cathartics, some choice as to time can occa- 
sionally be indulged. For example, if the pilular form be chosen, and 
a substance difficult of solution be selected, it may be taken at bedtime. 
Accordingly, pills of mild chloride of mercury — to be followed the next 
morning by a saline or other soluble cathartic — are directed to be taken 
at the time of retiring to rest. On the other hand, saline aperients, cas- 
tor oil, &c, are generally given in the morning, their operation being 
more speedy, and therefore more likely to disturb the patient if admi- 
nistered at night. Very early in the morning, when the stomach is en- 
tirely empty, a small dose of a cathartic often operates as speedily, and 
effectually, as a much larger taken after breakfast. Of course, when 
the administration of cathartics is imperiously demanded, no opportunity 
is left for choice of time. 

During the action of cathartics, the dermoid system is extremely im- 
pressible ; and if the patient be exposed to the partial and irregular 
application of cold, derangement of capillary action is apt to be induced, 
and if there be any tissue or organ, particularly liable at the time to 
take on diseased action, it will be apt to assume it. Should the cathar- 
tic operate more frequently, or more powerfully, than is desirable, a 
few drops of laudanum may be given in a glass of water; or a starch 
and laudanum enema may be administered. The latter, however, is 
rarely necessary. 

ENEMATA. 

Cathartics may be exhibited so as to act on the lower part of the in- 
testinal tube by direct application. In this form, they are termed 
cathartic glysters, enemata, or lavemens. When put in contact with 
the lining membrane of the rectum they irritate it ; and, by sympathy 
of continuity, their influence is extended to the intestinal canal. Hence, 
they may be administered with advantage, when cathartics cannot be 



1 50 CATHARTICS. 

given by the mouth, as where deglutition is impracticable. Accordingly, 
I in apoplexy, trismus, &c, this is a mode of exhibiting purgative and 
/ other remedies often had recourse to. It is obvious, too, that glysters 
' may be used with advantage to aid the operation of cathartics ; and, in 
cases of extreme debility, in which apprehension is entertained, that 
cathartics administered in the ordinary'mode may act too powerfully, 
glysters can be advantageously substituted. They are most valuable 
agents, and, until of late, have been too little employed in this country, 
as well as in Great Britain ; but, on the continent of Europe, they form 
a part of the boudoir of every female ; and are regarded indispensable 
to cleanliness and to health. In the Malade Imaginaire of Moliere, 
Argan appears on the stage, reading his apothecary's bill, in which the 
clyster and its adaptation occur over and over again, without any feel-, 
ing of outraged delicacy on the part of the auditors ; whilst with us the 
slightest allusion to the operation or the instrument cannot be mentioned 
to ' ears polite.' 
^ Even cold water, thrown into the rectum, excites the peristole of the 
intestines, and produces a salutary effect in inflammation of the lining 
membrane; — the cooling influence being propagated upwards, by virtue 
of the extensive sympathy that exists between every part of the surface. 
In the same manner, warmth can be applied so as not only to act as a 
fomentation to the parts with which the material of the glyster comes in 
contact, but to have the soothing effect extended to parts above ; and, 
by means of contiguous sympathy, to organs seated in the vicinity of 
the lower portions of the tube. With both these views enemata are 
administered ; but they are chiefly used for the purpose of stimulating 
the canal, so as to occasion the evacuation of its contents. For this 
purpose, warm water, soap and water, salt and water, molasses and 
water, or gruel with the addition of salt or castor oil, are generally the 
selected vehicles; and if the desire be to excite considerable revulsion 
in the rectum, oil of turpentine may be added, either formed into an 
emulsion with the yolk of egg, or simply mixed with the gruel or other 
constituents of the enema. At times, where the idea exists, that con- 
stipation is the effect of spasm in some part of the canal, the tobacco 
glyster is directed. This may be given either in the way of infusion or 
of smoke, which latter may be thrown up through an ordinary tobacco- 
pipe ; — the tobacco being placed in the bulb. It is then ignited, and 
the bulb being put into the mouth, the smoke may be readily forced 
into the intestinal canal, by blowing through the tube. The exhibition 
of tobacco in either mode is attended, however, with danger ; and 
therefore it ought to be had recourse to with great caution. Cases, as 
elsewhere remarked, are on record of fatal results from an infusion of 
the strength directed in the pharmacopoeias. 

When glysters are administered by the ordinary bag and pipe, they 
rarely go farther than the rectum, and may therefore fail altogether in 
their operation. The syringe employed of recent date is capable of 
propelling the enema farther; but, at times, it also fails, especially 
where there is any obstruction at the termination of the sigmoid flexure 
of the colon, as is not unfrequently the case. Dr. O'Beirne has very 
properly directed attention to this point in the pathology of defecation, 



SUPPOSITORIES. 151 

and has advised, that an elastic gum tube, like the ordinary stomach 
tube, should be gently insinuated through the narrow portion at the sig- 
moid flexure, until it enters the colon ; in this way, liquid faeces or 
flatus, are occasionally brought away after every ordinary remedy has 
failed ; and by attaching the external extremity of the tube to the 
stomach pump, an enema may be projected into the colon and prove 
effectual, when <he ordinary enemata, as usually exhibited, may have 
been administered in vain. 

Some years before the appearance of Dr. O'Beirne's observations, 
the author had an interesting case. of obstruction of the bowels in an 
aged individual, - who, for almost the whole period of his existence, had 
held an honourable situation in his country's service. In this case, the 
colon appeared to be much distended by flatus. Injection after injec- 
tion was thrown up by the only means at hand — the bag and pipe — but 
no relief was obtained. The symptoms became more and more urgent. 
Under these circumstances, the idea occurred, that if a hollow instru- 
ment could be passed up until it reached the part of the colon above 
the seat of the constriction, relief might be obtained. Accordingly, a 
large sized elastic-gum male catheter was passed, with some difficulty, 
through the sigmoid flexure, and as soon as its extremity attained the 
colon, a considerable discharge of fetid gas took place, and relief was 
instantaneous. This agency would probably be completely successful 
in affording relief, in those cases in which it has been advised to force 
air into the intestines for the removal of colic occasioned by the pre- 
sence of air there ; — a plan of treatment, by the way, which is minutely 
described by Swift, and the invention assigned to a medical philosopher 
of the Academy of Lagado. 

The quantity of fluid to be administered in the way of enema must 
vary according to age, and other circumstances. For an infant, a few 
ounces may be sufficient ; for an adult, from a pint to a quart ; but if the 
desire be to wash out the colon, a considerable quantity may be neces- 
sary. In all cases, when given to produce a cathartic operation, the 
fluid ought not to be sent in too rapidly, as it is apt to excite the rec- 
tum to immediate action, so as to occasion its return, without bringing 
along with it more than the contents of that gut. The enema ought to 
stay long enough to excite, by sympathy, the whole tract of the large 
intestines at least; and, therefore, if it comes away in a few minutes — 
and especially if the discharge has but little faecal matter mixed with it- — 
it ought to be repeated. 

SUPPOSITORIES. 

It has been already remarked, that glysters are excellent revellents, 
when composed of materials possessed of excitant properties. The 
same may be said of 'suppositories,' which- are special excitants, or 
ordinary excitants, according to the ingredients of which they may be 
composed. In early infancy, they are often employed to open the 
bowels, and are usually co posed of turpentine soap, — a small conical 
piece, moistened, being forced up into the rectum, and left there, when 
it generally produces a free evacuation of the lower part of the canal. 
At times, the soap is smeared over with castor oil ; at others, with tur- 



152 CATHARTICS 

pentine, to add to the cathartic effect. In this way, as well as by glys- 
ter, any medicinal agent may be brought to affect the rectum ; and 
accordingly, cathartics, opiates, &c, are so administered. 

It has been proposed to introduce a kind of galvanic suppository, 
made of two metals— zinc and copper— into the rectum, for the removal 
of constipation ; and this has been attended, in some cases, with good 
effect ; not, probably, in consequence of any specific excitation of the 
nerves of the rectum by galvanism, but by its acting as an ordinary 
excitant to the nerves of the mucous membrane. 

Another mode of employing the galvanic excitation is by forming a 
connection between two different metals ; one being introduced into the 
mouth, the other into the rectum ; but this apparatus is not possessed 
of more energy than the first ; and both are perhaps largely indebted for 
their action to the local excitation which their presence in the rectum 
engenders. The public and even the profession have been amused by 
various instruments, invented for the application of galvanism to differ- 
ent parts of the body ; and if their efficacy on the frame has not been 
well marked, they have not failed to minister to the pockets of their 
inventors. 

Dr. A. T. Thomson remarks, that the peristaltic action of the intes- 
tines may be increased by various external means ; and, of these, he 
instances the electrical aura as highly useful in "simple torpor of the 
gut ;" and the dashing of cold water on the lower extremities, which 
has succeeded in procuring the immediate evacuation of the intestines 
" in obstinate costiveness, particularly in the case of ileus, when all 
other means have failed." Both these agents produce their effect less 
as special excitants, than by modifying the nervous distribution. We 
have already seen, that there are many nervous modifications, — those 
through the influence of the mind especially, — which act upon the 
intestinal canal, so as to produce catharsis. 

Therapeutical Jipplication of Cathartics. 

The therapeutical application of cathartics will now be intelligible. 
They may, of course, be employed with various objects: — either to 
act as simple evacuants, as depleting agents, or as revellents. 

Fever. — In the disordered state of functions, constituting general 
fever — whatever may be its variety — their use is, throughout the dis- 
ease, more or less indicated. In the state of erethism that exists in 
every portion of the dermoid structure, morbid secretions are neces- 
sarily formed, which, if not removed, induce irritation ; yet although 
cathartics of a mild kind are needed to keep the intestinal canal free, it 
is — as has been before observed — a great mistake to over-excite the 
lining membrane of the intestines by drastics, in diseased conditions in 

which the absence of all irritation — mental as well as corporeal ought 

to be inculcated ; and this remark applies especially to fevers, which 
are apt to be accompanied by unusual irritation in the mucous mem- 
brane of the stomach, and small intestines. The plan to be pursued in 
such cases seems to be clearly indicated, — to attack the local inflamma- 
tion, and the general increased action, by bleeding— general and local 



IN FEVER. 153 

—rand by the use of refrigerants ; io keep the canal free by cathartics 
of the mildest kind, as a tea-spoonful of the oleum ricini, repeated at 
intervals if necessary ; and, under this system, the issue is, according 
to the author's experience, far more fortunate than where much irrita- 
tion is kept up in the canal. Reflection, indeed, suggests at a glance, 
the impropriety and inconsistency of any irritating plan of medication 
in fever. We carefully employ sedative agents ; recommend the most 
careful abstraction of light, and sound, and the avoidance of all irrita- 
tion, except that which we officiously excite in a part of the system, 
which possesses intimate sympathetic relations with every other part of 
the organism ; and, under this mode of management, many cases of 
continued and remittent fever, doubtless, run their course to a fatal ter- 
mination, which, under a better system of treatment, would have termi- 
nated in health. It must be borne in mind, that, in these cases, the 
objection is not to cathartics in the abstract. The employment of mild 
cathartics to keep the alimentary tube entirely free from all morbid 
secretions must be regarded as one of the most important points in the 
management of fevers, that are even accompanied with an unusual 
degree of erethism of the gastro-enteric mucous membrane. It is the 
powerfully irritating cathartic — that excites evacuation after evacuation, 
and exhausts the patient by irritation — which is so objectionable. The 
author is satisfied, that many cases of continued and remittent fever have 
arrived at a happy termination by the treatment above recommended, 
which might have eventuated unfortunately, had the irritating cathartic 
agency, so strongly inculcated by several distinguished teachers and 
authors, within so late a period as the last fifty years, been adopted. If 
we cast our eyes over the periodicals that are daily emanating from the 
press, we find that such agency is now less and less invoked, although the 
attention of the practitioner is equally directed to the gentle removal 
of all offending matters from the intestinal canal. Laxatives, or gentle 
cathartics — in other words — have taken the place of the more violent ; 
and the improvement has been signal. 

The evils of this perturbating system of treating fevers have been for- 
cibly depicted by Dr. Stokes. " A common practice" — he says, u has 
prevailed in these countries, and indeed still exists to a very great ex- 
tent, of making the patient take purgative medicines every day ; and 
this, I regret to say, is too often done even in cases where the surface 
of the small intestine presents extensive patches of ulceration. Now, I 
will ask you, can any thing be so barbarous as this, or can it be ex- 
ceeded in folly or mischief by the grossest acts of quackery ? Here we 
have an organ in a state of high irritation, and exhibiting a remarkable ex- 
citement of its circulation, and yet we proceed to apply stimulants to that 
organ and to increase the existing irritation. Would it not be absurd, 
in a case of inflammation of the knee or elbowjoint, to direct a patient 
to use constant exercise and motion ? Would it not be a very strange 
practice to apply irritants to a raw and excoriated surface ? Yet some- 
thing equally absurd and equally mischievous, is done by those who 
employ violent purgatives in a case of inflammation of the digestive tube 
in fever. This has been a great blot in the history of British practice. 
Calomel and black bottle, and even jalap and aloes, and scammony 



154 CATHARTICS 

have been prescribed for patients labouring under severe and extensive 
dothinenteritis. Morbid stools are discharged, and the more morbid 
they are, the more calomel and purgatives does the physician give to 
change their character, and bring them back to the standard of health. I 
want words to express the horrible consequences. Too often have I 
seen fever patients brought into the hospital with diarrhoea, hyperca- 
tharsis, and inflammation of the mucous membrane from the use of pur- 
gatives administered before their admission. Practitioners will not open 
their eyes. They give purgatives day after day, a very easy practice, 
and one for which there are plenty of precedents ; but it is fraught with 
the most violent consequences. I will freely admit, that the disciples of 
the school of Broussais have gone too far in decrying the use of laxatives 
altogether. But if they have lost hundreds by this error, British prac- 
titioners have killed thousands by an opposite plan of treatment. . In 
cases of fever where there is no decided symptom of gastro-enteric dis- 
ease, there can be no objection to the use of laxatives, if required, but 
they should always be of the mildest description. You will gain nothing 
by violent purging in fever ; mild laxatives alone can be employed ; 
and where there is any sign of intestinal irritation present, even these 
should be used with caution. There is one mode of opening the bowels, 
which you may always have recourse to with advantage in fever, viz., 
the use of enemata. There is not the slightest doubt, that occasionally 
accumulations of faecal matter will take place, and tend to keep up irri- 
tation, but they should alwa)s be removed with the least possible risk 
of producing bad consequences. To purge in fever when intestinal irri-" 
tation is present, is a practice opposed alike to theory and experience, 
and I have already stated that its results are most horrible." 

In fevers of the synochal or inflammatory kind, unaccompanied by 
much gastro-enteric irritation, more powerful cathartics may be em- 
ployed, the object being to use them as depleting agents, as w-ell as for 
the purpose of evacuating offending matters. In such cases, recourse 
is more commonly had to saline cathartics, which, by exciting the action 
of the exhalantsof the mucous membrane generally, occasion the evacu- 
ation of a portion of the more watery parts of the blood. 

It has been inculcated by many therapeutists, that whenever the 
evacuations are fetid or ill-conditioned, it is necessary to repeat the 
cathartic, until their natural healthy character is restored; but if the 
alimentary canal be kept clear from the commencement of the disease, 
it can rarely happen, that this fetid character will be marked, or to such 
an extent as to demand much attention. Besides, it must be recollected, 
that they may be rendered ill-conditioned by the employment of these 
very agents. When the mild chloride of mercury, for example, is ex- 
hibited for some time, it modifies the secretion from the different glan- 
dular and follicular organs, and gives occasion, as before mentioned, to 
green or dark coloured evacuations — < calomel stools' — very much re- 
sembling chopped spinach. This has, of course, to be borne in mind, 
as under the idea just mentioned, which prevails largely amongst those 
who do not reflect, the cathartic might be repeated with the View of 
removing the very condition it has induced. Dr. Chapman, of Phila- 
delphia, has recommended, that in obstinate remittent and intermittent 



IN THORACIC AND ABDOMINAL INFLAMMATION. 155 

autumnal fevers cathartics should be cpntinued until dark, tarry, fetid 
stools are discharged. This dark appearance he conceives to be a 
glutinous matter, which adheres to the intestines, and requires cathartics 
for its removal ; but it appears by no means clear, that it may not be, in 
part, the effect of the repeated employment of cathartics deteriorating 
the intestinal secretions. 

From what has already been said, it will obviously be improper to 
administer violent cathartics in yellow fever; which, like malignant 
remittents, is accompanied by malignant gastritis or gastro-enteritis. 

Intermit tents. — In intermittents, cathartics are rarely employed for 
cutting short the disease. The impression they make upon the nervous 
system is not sufficiently intense to break in upon the morbid catenation. 
They are generally employed in such cases for the purpose of removing 
the contents of the alimentary tube, so as to prepare the way for the 
administration of cinchona, or of some of its preparations, or of other 
antiperiodics ; and in the progress of the affection, they are prescribed — 
as in other maladies— "-for removing morbid secretions, or whenever the 
bowels are in such a condition as to require their employment. 

In all cases, where a doubt may exist as to the propriety of prescrib- 
ing cathartics, there may be none as to the exhibition of enemata. They 
are, indeed, invaluable agents where the powers of life are so much 
reduced, that a rational fear is entertained as regards the administration 
of cathartics by the mouth. Even when food has not been taken, the 
canal must be kept free ; as the vitiated secretions, and the product of 
the digestion of the different substances poured into the digestive tube, 
cannot fail, by their retention, to add to the irritation. 

Eruptive fevers. — In all the exanthemata, the employment of gentle 
cathartics is indispensable to their judicious management. In small-pox, 
measles, scarlatina, &c, — where the cutaneous surface is affected with 
erethism, — the extension of the skin, constituting the mucous mem- 
branes, and especially the gastro-intestinal, cannot fail to participate in 
the general morbid condition ; to have their secretions depraved ; and, 
consequently, to require the administration of evacuants. 

With regard to the kind of cathartic best adapted for febrile affections 
in general, there is none perhaps so available ^s the oleum ricini. Next 
to this, the different salines, especially the sulphate of magnesia ; and, 
if stronger cathartics are required, — which, as has been remarked, hap- 
pens far more rarely than has been imagined — the pulvis jalapce compo- 
situs — which consists of jalap and bitartrate of potassa ; or combinations 
of jalap and calomel, or of rhubarb and calomel. Where the object is, 
as in fever, to remove all offending matters daily, and once a day, from 
the alimentary canal, and not to excite a powerful revulsion, or a copi- 
ous exhalation from the mucous membrane, the most unirritating agents 
ought obviously to be chosen ; and of these, the oleum ricini is deci- 
dedly the best. 

Thoracic and abdominal inflammation. — Cases of thoracic inflam- 
mation do not exhibit any signal advantage from the employment of 



156 CATHARTICS 

cathartics. These can act only by virtue of their depletory or revulsive 
properties, and their administration must be guided by general princi- 
ples ; but in inflammatory affections of the contents of the abdomen, or 
of its lining membrane, great care and discrimination are required to 
decide upon their utility, or the contrary. 

In peritonitis, whether implicating the peritoneum proper, or its ex- 
tensions investing the intestines, cathartics have^ to be employed with 
caution, for fear the irritation excited during their operation should add 
to the inflammation. In such cases, Dr. William Saunders was in the 
/habit of saying, that the best mode of opening the bowels— in enteritis 
■ especially, which is usually attended with constipation — is the use of the 
lancet ; and if this be followed up by a full sedative dose of opium, the 
bowels will often respond without the aid of any cathartic. The consti- 
pation is, in such cases, dependent upon the inflammation ; and when 
this — the cause — is removed, the effect will yield also. Where enteritis 
is seated in the mucous coat, irritating purgatives should be given with 
extreme care. A case, indeed, can scarcely be imagined, in which they 
can be indicated ; yet the exhibition of a gentle cathartic, — simply with 
the view of keeping the canal free from morbid secretions, and morbific 
matters, which cannot fail to be present in such a diseased condition of 
the lining membrane, — is amongst our most valuable means of medica- 
tion. This is signally the case in dysentery, — in which the inflamma- 
tion is chiefly seated in the lower portion of the intestinal tube, — and in 
the early stages of cholera common as well as spasmodic. 

In diarrhoea, which arises from irritation of the lining membrane of 
the intestines, it was at one time the custom to employ no agents of any 
kind. The disease — as already remarked — was looked upon as an effort 
of nature not to be interfered with ; whilst by others, an opposite view 
has been maintained, and astringents have been advised from the com- 
mencement. Of the two views, the latter is more markedly erroneous, 
and mischievous in its consequences. The disease is one of irritation, 
and the exciting cause is often extraneous matters in the intestines them- 
selves ; accordingly, it may be maintained, as an almost, universal rule, 
that gentle cathartics should be exhibited in the first instance, and be 
repeated if necessary ; and that astringents should not be used, unless 
an asthenic condition should supervene, — as in the gleet, which gene- 
rally succeeds to acute inflammation of other mucous membranes. 

If the propriety of the use of gentle cathartics in the case of diarrhoea 
affecting adults be admitted, the remark must apply a fortiori to the 
diarrhoea of infants, who are extremely liable to erethism of the dermoid 
tissue, and to the formation of acid in the primae viae, which has often 
considerable agency in the development of the disease ; hence the acid 
smell of the evacuations. Often, too, accompanying this state, there 
are manifest indications of an inflamed condition of the gastro-enteric 
mucous membrane. 

Dyspepsia.— -In the variety of dyspepsia, which consists of an irritated 
condition of the lining membrane of the stomach, violent cathartics are 
improper; but laxatives may be — and usually are — indicated. Indeed, 
in atonic dyspepsia, the same system is advisable ; and an occasional 



1 



IN HEMORRHAGE. 157 



brisk cathartic may be exhibited with advantage. When employed in 
this manner, a(^lHp is given to the digestive function, which is often 
salutary ; whilst if the cathartic be often repeated, a degree of sensi- 
bility and irritability may be induced in the bowels, which cannot fail to 
add to the mischief. *> 

Hepatic diseases. — In hepatic phlegmasia, engorgement, or torpor, 
cathartics have been regarded as eminently useful, by acting immediately 
on the radicles of the portal veins ; and thus diminishing the quantity 
of fluid, that passes to the liver by the vena porta. From what has been 
remarked, regarding the use of emetics in jaundice, and in cholelithus 
or gallstone, it will be understood, that cathartics may have a beneficial 
agency, by stimulating the intestinal tube, — the excitation being con- 
veyed by continuous sympathy to the liver and its accessaries; but 
where there is organic mischief, as happens in most of the protracted 
cases— especially such as occur in those of broken down constitutions 
— they must be given with caution. 

Constipation. — Of the utility of cathartics in constipation we have 
already treated. They ought not — as there stated — to be administered 
in such doses as to act as powerful local stimulants, on account of the 
depression which always succeeds to the superexcitation. The proper 
mode is to prescribe them in small doses, often repeated along with a 
properly regulated diet. A brisk cathartic may obviate the constipation 
for the time ; but no permanent cure can be effected, without^triking at 
the root of the evil, by a proper and protracted laxative treatment and 
regimen. 

Colic. — In the different varieties of colic, cathartics have been much 
employed. The intestinal pain is generally caused by over-distention of 
the coats by flatus, or by accumulated or irritating aliments ; and the 
method usually adopted for removing the disease is to excite the peri- 
staltic action of the intestines, so as to diffuse the flatus over a larger 
surface, or to remove the source of irritation. This may often be effected 
by a union of cathartics and aromatics, or, when the pain is extremely 
violent, by the substitution of an opiate for the aromatic, to allay the 
spasm, which forms a part of the disease. Perhaps in all cases of colic, 
the best course is to premise a full dose of an opiate, and afterwards to 
administer a cathartic by the mouth or rectum, should this be necessary. 

Hemorrhage. — The rules that guide us in the administration of ca- 
thartics in hemorrhage vary according as it is of the active or passive 
kind. In the former they may be proper; in the latter not. In apo- 
plexy, they are employed both as depletives and revellents ; but more 
for the latter purpose than the former. During the apoplectic seizure, 
one of the best revellents is a stimulating enema; and this can be ad- 
ministered when deglutition is impracticable. Croton oil is also given 
under similar circumstances. If a drop of this be put upon the tongue, 
it passes by imbibition into the blood-vessels, and seeks out the intesti- 



158 CATHARTICS 

nal canal for its operation, by virtue of that singular action of preference, 
of which there are so many marked examples. ■ 

In the epistaxis, that occurs about the period of puberty, the deple- 
tion and revulsion produced by a full dose of sulphate of magnesia are 
often sufficient to put a stop to it ; and, whenever signs of vascular ac- 
tivity exist, in it or in other hemorrhages, cathartics are clearly sug- 
gested. The same may be said of their employment in cases of hasmop- 
tysis, although mental and corporeal quiet are absolutely necessary 
during the attack, and for some time afterwards ; but, in the interval, 
no doubt can arise as to the propriety of their administration. The sa- 
line cathartics, which operate upon the whole of the intestinal canal, 
and augment the exhalation from the mucous membrane, ought to be 
selected. 

In haematemesis or vomiting of blood, whilst cathartics have been 
strongly recommended by some, they have been as warmly reprobated 
by others. The German practitioners generally object to them ; yet 
the objection does not appear to be well founded. A saline cathartic, 
by acting upon the whole of the intestinal canal, developes a succession 
of sympathies during its operation, which derives greatly from the con- 
centration of vital activity towards the stomach, that, is present in active 
haematemesis. Besides, certain of the saline preparations — as before 
shown — are somewhat astringent ; the supersulphate of magnesia, of 
potassa, or of soda, for example, — which may be formed extempo- 
raneously, by adding the elixir of vitriol, or the dilute sulphuric acid, 
to a solution of sulphate of magnesia, of sulphate of soda, or of sulphate 
of potassa, — comes in contact with the vessels pouring out the blood 
by rupture or transudation, and by its directly astringent properties 
arrests the hemorrhage, and its cathartic agency may prevent a recur- 
rence. It has been stated, elsewhere, that many cases of haematemesis 
are dependent upon obstruction in some other organ than the stomach, 
— and especially in the uterus ; and where there is torpor of this last 
viscus — such as exists in many, if not in most cases of amenorrhma — 
the action of the cathartic is well adapted for communicating a salutary 
excitation to the uterine functions, through contiguous sympathy. 

In menorrhagia, care has to be taken in the administration of ca- 
thartics owing to the fact just mentioned, — that they excite the action 
of the uterus by the sympathy of contiguity ; but in hematuria, such 
cathartics as are not accompanied with a diuretic operation may be 
beneficially employed, — the derivation of nervous and vascular influx 
from the urinary organs being attended with good effects. With this 
view the oleum ricini is had recourse to with advantage. 

Hemorrhoids. — In hemorrhoids, the mildest kinds of cathartics are 
serviceable ; whilst the more violent are injurious. Obviously, too, 
such cathartics should be avoided as act upon the lower portion of the 
alimentary tube ; unless some addition be made to them, which rids 
them of their objectionable features. Accordingly, when aloes is given, 
it is generally in small doses, and associated with some narcotic,— as 
hyoscyamus. The mild chloride of mercury is a cathartic, which'gen- 
eraJly acts more energetically upon the upper portion of the intestines ; 



IN NEUROSES. 159 

but, with some, it irritatesthe rectum ; and, consequently, such indivi- 
duals should avoid its use when affected with hemorrhoids or any 
disease of the rectum. Castor oil, and sulphur, are the best laxatives 
in such cases. These remarks apply equally to procidentia, in which 
drastic cathartics could not fail to do mischief. 

Pregnancy. — In pregnancy, powerful cathartics must be avoided, for 
reasons that have been previously assigned. 

Head affections. — In various head affections, and especially in ence- 
phalitis^ whether involving the brain or its membranes, or both, — 
cathartics would clearly be advantageous, by virtue of the revulsion 
they effect, did not the inconvenience, to which the patient is subjected 
by the motion necessarily attendant on their operation, often preclude 
their employment. 

In mania, they are, at times, absolutely required, in consequence of. 
the torpor, that occasionally exists in the intestinal tube. From this 
cause, an accumulation at times takes place in the large intestines to a 
surprising extent ; and the use of the scoop is required to remove the 
indurated faeces that have collected in the rectum; after which, injec- 
tions of cold water may be thrown into the large intestine to restore its 
tone. 

Owing to the torpor of the nerves of the tube, or rather to the cere- 
bral abstraction and excitation, which prevent the usual sensitive im- 
pressions from being duly appreciated, the most violent drastics are 
occasionally demanded — as oleum tiglii, or elaterium — and even these 
are often ineffectual, unless blood-letting is premised, which, by reducing 
the nervous energy, enables smaller doses to produce the wished- 
for operation. Sometimes, considerable difficulty is experienced in the 
administration of any remedy by the mouth, — the patient obstinately 
closing the jaws, and resisting every effort to separate them. This de- 
termination may be broken in upon — especially after blood-letting — by 
pressing strongly on the parotid gland, which occasions so much pain, 
that the maniac yields, and the jaw is depressed. 

Neuroses. — In all the neuroses, it is important to keep the intestinal 
tube free ; as irritations, seated there, react upon the cerebro-spinal 
axis, and add to the mischief. 

Hysteria, which is ranked, though improperly, by Pinel, in accord- 
ance with antiquated notions, as a nevrose de la generation, is often as- 
sociated with this condition of the bowels; and therefore requires the 
use of cathartics. Great nervous torpor of the whole system is present 
in many cases of this protean malady, requiring the administration of 
cathartics as revellents, both by the mouth, and rectum. 

Under the head of emetics it was remarked, that irritations of the 
stomach and bowels, produced by improper diet or by morbid secre- 
tions, are a grand exciting cause of epilepsy, as well as of infantile con- 
vulsions. Cathartics are, therefore, almost universally proper in these 
alarming attacks ; but care must be taken not to repeat them sufficiently 
often to develope the sensibility of the tube, as they might react on the 



160 CATHARTICS. 

cerebro-spinal axis, and augment the very -mischief which they were 
administered to remove. 

Chorea— a disease of the nervous centres, accompanied with great 
torpor of the digestive function— requires a union of tonics with cathar- 
tics for its removal. Dr. Hamilton, of Edinburgh,— who has been the 
cause of much valuable use, and at the same time of much abuse of the 
cathartic medication,— places his main reliance on it, in the cure of this 
singular affection. 

One of the varieties of trismus— the trismus nascentium or "lock- 
jaw of the new-born," is often dependent upon irritations seated in the 
intestinal canal, and is occasionally removable by gentle cathartics, as 
the oleum ricini. In this part of the Union, it is rarely witnessed ; but 
in the southern and warmer regions, it is a fatal malady. At the Ha- 
vana, according to Don Ramon de la Sagra, of one hundred children 
dying under ten years of age, nineteen per cent, amongst the whites 
perish of it within the first seven days, and twenty-four per cent, 
amongst the infants of colour. Whence the affection is called there the 
" disease of the seven days" {mal de los sieta d>as). 

In violent cases of tetanus in the adult, cathartics constitute one of 
the agents to which recourse is almost invariably had, along with other, 
and more essential, — as narcotics. When swallowing is impracticable, 
stimulating enemata are often administered, with the view of exciting a 
new impression by revulsion ; or opium is given in the same manner, 
where the object of the practitioner is to endeavour to overpower, by 
sedatives, the inordinate erethism of the cerebro-spinal axis. When 
deglutition can be effected, a union of cathartics and opiates is often 
employed to fulfil similar views. The oleum tiglii is, in these cases, a 
useful cathartic, both when deglutition exists, and when it is impracti- 
cable. 

Dropsies. — Cathartics are among the most valued, and valuable 
agents in the treatment of dropsies, especially when these are of an ac- 
tive kind. In the passive, they must necessarily be used with more 
caution. The division of cathartics, to which recourse is had, is that . 
of drastics, and such especially as produce copious watery discharges, 
— or in other words, as act powerfully on the secretory apparatus of the 
mucous membrane of the alimentary canal. Elaterium is one ; but it 
must be cautiously administered on account of the difficulty that exists 
in regulating its operation. Calomel and gamboge are often selected 
for this agency. — These hydragogues — as before mentioned — act in two 
ways in the curation of dropsy ; first, they diminish the amount of cir- 
culating fluid, and thus add to the activity of imbibition ; and secondly, 
they, excite a powerful revulsion, which gives rise, indirectly, to sorbe- 
facient agency. 

Intestinal worms. — Cathartics are often employed as anthelmintics; 
but their main effect can only be the removal ot existing worms ; they 
do not prevent their re-formation ; besides, if often given, thev may de- 
bilitate the system generally, and the digestive function in particular, 
and thus favour the predisposition to the development of those para- 



SPECIAL CATHARTICS. — MANNA. 161 

sites. On the other hand, however, an occasional brisk cathartic may 
give, rather than diminish, tone, by breaking in upon the monotonous 
execution of functions, and exerting a salutary impression of excitation. 

Such are the chief disorders and purposes for which cathartics are 
administered. It is obviously almost as impracticable, as it is unneces- 
sary, to refer to every case, in which their employment may seem to be 
indicated. Their main effects on the general system are — depletion 
and revulsion ; and a wise discrimination will suggest the particular 
cases, in which such agency is demanded. Their immediate effects 
upon the parts with which they come in contact are obvious; and a very 
slight degree of reflection — after the pathological lesion has been cor- 
rectly appreciated — will enable the practitioner to decide as to the pro- 
priety of their administration. 



SPECIAL CATHARTICS. 

I. Laxatives or Mild Cathartics. 

1. MANNA. 

Manna is the concrete juice of Ornus Europcea, Frixinus Ornus or 
Flowering Ash ; Sex. Syst. Diandria Monogynia; Nat. Ord. Oleaceae 
(Lindley) ; a native of the south of Europe, especially of Calabria and 
Sicily. It is chiefly obtained by making incisions in the stem. It also 
issues in part spontaneously from fissures ; and in part from punctures 
made by an insect, the Tettigonia Orni or Cicada Orni. The juice, 
as it issues, is nearly colourless, and somewhat viscid ; but it soon con- 
cretes in the sun into a yellowish opaque substance. Some of it is 
permitted to fall on the ground, or on leaves placed to receive it ; or to 
trickle down the trunk; but where care is taken, the leaves of the ornus 
are stuck into the bark below the incisions, which guide it to receptacles 
formed of leaves of Cactus Opuntia or Indian Fig ; and straws and 
twigs are inserted into the incisions, so that the juice concretes in the 
form of stalactites, and is readily detached clear from the bark. The 
collection of manna commences in July, and continues till October, — 
the best kind being obtained during the month of August, or in the 
height of the season ; and the inferior qualities towards the close. 

Manna is imported chiefly from Palermo and Messina, but likewise 
from various parts of Italy and Sicily. The quantity, on which duty 
was paid in England in 1839, according to Dr. Pereira, was 13,493 
pounds. There are several varieties met with in commerce. The one, 
which is the purest, is Flake Manna — Manna Cannulata — which is 
in irregularly shaped pieces resembling stalactites, and obtained in the 
manner above mentioned. It is light, brittle, of a white or pale yellowish 
white colour; has a faint, rather pleasant odour, and a sweet somewhat 
peculiar taste, becoming ultimately rather acrid. When broken, flake 
manna has a crystalline or granular structure. 

Vol. L— 11 



162 SPECIAL CATHARTICS. 

Manna in sorts or Common Manna consists of whitish or yellowish 
fragments similar to the last variety, but smaller, and mixed with a soft, 
viscid, uncrystallized brownish mass, like that which constitutes the com- 
monest variety — the fat or fatty manna, which is in the form of a soft 
viscous mass, of a dirty yellowish-brown colour, containing few crystal- 
line fragments, and full of impurities. Under the name Sicilian Tolfa 
Manna, Dr. Pereira describes an fnferior kind, corresponding to the 
manna in sorts. It is thought by him to correspond in quality to Tolfa 
Manna, produced near Civita Vecchia, which is but little valued. 

Manna has frequently been subjected to analysis, and been found to 
contain about 60 per cent, of a peculiar sweet principle called mannite; 
a little common sugar, partly crystalline and partly uncrystallizable ; 
extractive matter; and about 32 per cent, of moisture. The extractive 
matter, which is nauseous, has been regarded as the laxative principle; 
yet mannite would seem to be as laxative as manna itself. 

Manna, like sugar, is nutritive ; but, it is not used with us on account 
of this property. It is a gentle laxative, yet does not always act with- 
out inducing tormina. By females and children it is occasionally taken 
alone ; but more frequently it is prescribed as an adjunct to other reme- 
dies of the same class, as senna, and sulphate of magnesia, whose taste 
it somewhat conceals, whilst it adds to their cathartic agency. Accord- 
ing to the author's taste, however, the addition of the manna is no im- 
provement. 

The dose for an adult, is from one to two ounces; for children from 
one to three drachms. In the case of the former it may be eaten; of 
the latter, it may be taken dissolved in water, simple or aromatic, or in 
tea or coffee. 

Mannite. — Mannite has been brought forward as one of the "new 
remedies." It is obtained by treating manna in tears with boiling 
alcohol ; then filtering and suffering it to crystallize : by rest and refrige- 
ration mannite is precipitated in small, beautiful, white needles. 

It is used under the seme circumstances as manna, and the dose is 
much the same. 

2. SULPHUR. 

Sulphur of the Pharmacopoeia of the United States is the sublimed 
sulphur of some other pharmacopoeias. It is found both in the inorganic 
and the organized kingdom. In the former, it occurs either embedded 
in rocks — common native sulphur ; or produced by volcanic action by 
sublimation— volcanic sulphur. In the organized kingdom, it is found 
in many plants ; — in the liliacese, for example, in parlic ; in the cruci- 
ferae, in mustard ; and in assafoetida of the umbelliferae. It is also found 
in certain animal substances, as eggs, urine, &c. In combination, in 
the state of sulphuric acid, it occurs extensively. It may be procured 
by purifying native sulphur, or by decomposing the native sulphurets; 
but the sulphur of commerce is generally obtained in the former way. 
It is brought chiefly from Italy and Sicily. During the year 1834, 



SULPHUR. 163 

according to Mr. McCulloch, not less than 507,808 cwt. of rough brim- 
stone were imported into England, of which 485,756 cwt. were from 
Italy, or rather Sicily. 

Native sulphur is met with in small quantities in different parts of the 
United States. 

Crude sulphur is prepared from native sulphur, either by being sub- 
jected to a rude process of fusion, or by a process of distillation in 
earthen pots. In this state, it is imported, and purified. The process, 
formerly adopted, was to submit it to fusion in an iron caldron ; when 
the earthy impurities subsided, and the liquid sulphur was ladled out 
and cast into moulds, so as to form roll sulphur or roll brimstone. The 
improved method of purification is to distil it in an iron still, the sulphur 
being allowed to pass into a chamber, on the walls of which it is depo- 
sited in the form of flowers of sulphur. If, instead of permitting the 
sulphur to enter the sulphur chamber, it be made to pass into an appro- 
priate receiver, the sulphur distils over, and condenses into a liquid, 
which, when solidified, constitutes the refined sulphur of commerce. 
If this be cast in wooden moulds, it forms the stick or roll or cane sul- 
phur or brimstone. 

Flowers of sulphur, or solid sulphur, may be prepared from the 
metallic sulphurets by similar processes. 

The dregs that remain after the purification of sulphur constitute 
sulphur vivum, formerly used externally, but now never employed 
except by the veterinary surgeon. It has hence obtained the name of 
horse brimstone. 

Sublimed sulphur, prepared by any of these methods, contains more 
or less sulphuric acid, owing to some of it undergoing combustion. 
This can be removed by washing, after which we have sulphur sublima- 
turn lotum of certain of the pharmacopoeias, and of the United States 
Pharmacopoeia of 1830. In the last edition, however, Sulphur means 
the sublimed article ; and Sulphur lotum or washed sulphur, sublimed 
sulphur thoroughly washed with water. As met with in the shops, it 
is in fine powder, of a bright yellow colour, and of a peculiar smell 
and taste. It is insoluble in water, but soluble in alcohol, ether, and 
the oils, — both fixed and volatile. It is wholly volatilized by heat, 
and ought not to change the colour of litmus paper. 

Sulphur is one of the gentlest laxatives ; producing scarcely any 
augmented secretion from the follicles and exhalants of the intestines. 
Being so mild in its action, it has been given in cases of pregnant females ; 
and it is a common laxative in hemorrhoidal affections. When it is 
necessary to add to its cathartic agency, magnesia, or bitartrate of 
potassa may form the adjunct. The great objection to sulphur is, that 
even its internal use occasions the patient to exhale a disagreeable 
sulphurous odour, owing to the formation of sulphuretted hydrogen. 
Sulphur in combination with bitartrate of potassa, or alone, mixed with 
molasses, has long been a favourite "purifier of the blood," and is 
often given, spring and fall, as a domestic remedy. Its dose, as a 
cathartic, is from 3j to 3ss. It may be given, as before remarked, in 
molasses, or diffused in milk. 



164 SPECIAL CATHARTICS. 

SULPHUR PMCIPITA TUM, PRECIPITATED SULPHUR, Lac sutphuris, prepared 
by decomposing a sulphuret of lime, by means of chlorohydric acid, 
was officinal in the British Pharmacopoeias, and is still so in that of the 
United States. It possesses no advantages over sulphur lotum. It is 
much whiter, and in a state of fine division. It is said to be exceed- 
ingly liable to adulteration, and, on this account, has been left out of 
the British Pharmacopoeias. According to Dr. Pereira, in the prepara- 
tion of nearly the whole of the precipitated sulphur, sulphuric acid is 
substituted for the chlorohydric, by which the product contains about 
two-thirds of its weight of sulphate of lime ; and he adds, that he was 
informed by an extensive manufacturer of the article, that a firm, the 
name of which he mentions, was almost the only one that bought the 
pure kind. 

Pure precipitated sulphur, like sublimed sulphur, is wholly volatilized 
by heat. 

3. MAGNE'SIA.-^MAGNE'SIA. 

Magnesia, calcined or burnt magnesia, is prepared by exposing 
carbonate of magnesia to a red heat in an earthen vessel, until the car- 
bonic acid is wholly expelled, and the protoxide of magnesium remains. 
It is a light, white powder, devoid of smell, and almost tasteless. Its 
specific gravity is 2.3. When moistened with water, it exhibits an 
alkaline reaction. It is very sparingly soluble in water, and less so in 
boiling water than in cold. It absorbs carbonic acid ; and, therefore, 
should be kept from contact with air. 

The tests of its purity, as given in the Pharmacopoeia of the United 
States, (1842,) are, — that it should dissolve wholly without efferves- 
cence in dilute chlorohydric acid, which would prove the absence of 
carbonate of magnesia, with which it is often mixed ; and that the 
solution in dilute chlorohydric acid should yield no precipitate with 
oxalate of ammonia, or chloride of barium, — proving the absence of 
lime, and of sulphates. 

Magnesia is a gentle laxative, and as such is employed in pregnancy, 
affections of the rectum, &c, where mild aperients are needed. It is 
especially valuable where constipation is attended with cardialgia from 
too great a secretion of the gastric acids; and in children it forms an 
admirable laxative, owing to the great predominance of acid in them. 
It is also readily taken by them, when mixed with milk, and sweetened. 
It is an excellent adjunct to carminative mixtures, where it is advisable 
to increase the peristole of the bowels ; and is often prescribed for this 
purpose to children. (Magnes. gr. xv ; 01. anisi, seu 01. carui gtt. iij ; 
Aquce f.Sj ; Sacchar. 3i. M. — Dose, a tea-spoonful occasionally.) Where 
diarrhoea is attended with acidity, as it often is, magnesia may be 
needed to facilitate the removal from the bowels of the redundant acid ■ 
but where it is desirable to neutralize the acid, and at the same time to 
induce a constipating effect, prepared chalk may be prescribed. 

The dose, as a cathartic, to an adult is from a scruple to a drachm ; 
to infants from two to eight or ten grains. Occasionally, it does not 



ficus. 165 

operate, owing to its not meeting with acid in the stomach : its action, 
in such cases, may be facilitated by drinking lemonade, which forms a 
citrate of magnesia that acts as a mild aperient. 

It is proper to remark, that where magnesia has been taken for a long 
time, and in large quantities, it has occasionally accumulated in the 
bowels, and given rise to unpleasant effects. 

4. MAGNE'SIJE CAR'BONAS.— CAR'BONATE OF MAGNE'SIA. 

Carbonate of magnesia, subcarbonate of magnesia, hydrated subcar- 
bonate of magnesia, magnesia alba, occurs, although not in great abund- 
ance, as a mineral ; but that of the shops is prepared on a large scale 
by decomposing sulphate of magnesia by an alkaline carbonate; the 
consequence of which is the precipitation of carbonate of magnesia. As 
it is prepared by the wholesale chemist, no formula for it is given in the 
Pharmacopoeia of the United States. The greater part of that which is 
used in this country is imported from Scotland. In New England, it is 
prepared from the bittern of the salt works, which consists chiefly of 
sulphate and muriate of magnesia ; and in Baltimore, it is made from 
the sulphate of magnesia extensively prepared there. 

Carbonate of magnesia is a light, white, inodorous, and almost in- 
sipid powder. It is nearly insoluble in water, but readily dissolves in 
aerated or carbonated water. It is distinguishable from pure magnesia 
by effervescing with acids. Its adulterations are the same as those of 
magnesia, and may be detected nearly in the same manner. 

The therapeutical properties of carbonate of magnesia are almost the 
same*as those of magnesia. As, however, it contains carbonic acid, 
this is set at liberty, when the salt meets with acid in the stomach, and 
is apt to excite flatulence. Its dose, asfc laxative, is from half a drachm 
to a drachm, given in milk, with which neither it nor magnesia mixes 
well without great care. Its admixture is facilitated by first rubbing it 
with syrup. 

A fluid magnesia has been much recommended by Sir James Mur- 
ray, and Mr. Dinneford. The preparation of the latter is said to contain 
from 17 to 19 grains of carbonate of magnesia in every fluidounce. It 
is a condensed solution of magnesia in carbonated water. 

5. FICUS.— FIGS. 

Figs, in the Pharmacopoeia of the United States, are the dried fruit 
of Ficus Carica, the Fig Tree, which is a native of Asia and Southern 
Europe, but cultivated in the gardens of this country. The figs, when 
ripe, are dried in the sun or in ovens, and are afterwards packed in drums, 
baskets or boxi?s. They are chiefly brought to the United States from 
Smyrna ; and the Turkey or Smyrna figs are the largest and sweetest; 
and therefore the best. Dried figs form a very considerable article of 
commerce in Provence, Italy, and Spain, besides affording, as in the 
east, a principal article of sustenance for the population. The annual 



166 



SPECIAL CATHARTICS. 



Fig. 15. 




Ficus Carica. 



importation into Great Britain has 
been estimated at about 20,000 
cwt. 

The chief constituents of figs 
are mucilage, and sugar of figs, 
which greatly resembles the sugar 
of the grape. 

Like other saccharine articles, 
figs are laxative ; and by virtue of 
their mucilage they are demul- 
cent likewise. They are eaten in 
cases of habitual torpor of the 
bowels ; and enter into the com- 
position of Confectio Sennas of 
the Pharmacopoeia. 

The split fig retains heat well, 
and is, therefore, occasionally 
applied to inflammatory tumours 
to promote suppuration. 



6. CAS'SIA FISTULA.— PURGING CAS'SIA. 

Cassia Fistula is thcfruit of Cassia Fistula, Caihartocarpus Fistula, 
Pudding pipe tree or Purging Cassia; Sex. Syst. Decandria Monogy- 
nia ; Nat. Ord. Leguminosse, which is supposed to have been origi- 
nally a native of Upper Egypt and India, whence it has spread to various 
places. It is now found abundantly in Hindostan, China, the East 
India and West India Islands, a*nd in South America. 

The fruit — the officinal portion — as imported from the East and West 
Indies and South America, is in pods, from nine inches to two feet in 
length, which are cylindrical, slightly curved, and of a dark brown, 
nearly black colour. Internally, the pod is divided into numerous thin 
transverse partitions, — and each of these contains a hard, flattened, oval- 
shaped seed, surrounded by a soft, black pulp resembling an extract. 

CAS'SUE FIS'TULE PULPA, PULP OF PURGING CASSIA, is separated by pour- 
ing boiling water on the bruised pods to soften the pulp; then straining 
first through a coarse sieve, and afterwards through a hair one, and boil- 
ing down to a proper consistence. When subjected to analysis, the 
common or African variety yielded 61 per cent, of sugar ; the American 
69 per cent. 

Cassia pulp is laxative in a small dose ; in a larger, purgative, but it 
does not act kindly, being apt to induce nausea, and tormina. It is 
rarely prescribed alone, — never perhaps in this country ; but enters as 
one of the laxative ingredients into the Confectio Senna of the Phar- 
macopoeia of the United States. Its dose as a mild laxative is stated to 
be 3j. to 3ij ; as a purgative, 3ij. to 3j. 



PRUNUM. 



167 



7. TAMARIN'DUS.— TAM'ARINDS. 



Tamarind is the preserved fruit 
of Tamarindus lndica ; Sex. Syst. 
Monodelphia Triandria ; Nat. Ord. 
Leguminosae ; a tree which is indi- 
genous in the East and West In- 
dies. The fruit is a pod from two 
to six inches long, which consists 
of a ligneous husk, enclosing a 
pulpy texture, w 7 hich is traversed 
by numerous branching fibrils, with- 
in which one or more seeds are im- 
bedded. The officinal part is the 
pulp between the seeds and husk. 
It is usually imported along with 
the seeds and preserved in sugar. 
Tamarinds are brought to this coun- 
try from the West Indies. 

When subjected to analysis, the 
pulp yields citric, tartaric and ma- 
lic acids ; bitartrate of potassa ; 
sugar, gum, vegetable jelly,, paren- 
chyma and water. It has an agree- 
able, sweetish acid taste, and rea- 
dily imparts its properties to water. 



Fig. 16. 




Tamarindus lndica. 



Tamarinds are gently laxative, but they are rarely given alone. They 
were formerly prescribed with other cathartics, as with infusion of 
senna; but have been considered — probably on insufficient grounds — to 
diminish the operation both of it and of the resinous cathartics. They 
form part of the Confectio Sennce of the Pharmacopoeia of the United 
States ; for which purpose they are digested with a small quantity of 
water, until they become of uniform consistence ; after which the seeds 
and filaments are separated by pressing through a hair-sieve. This is the 
TAIARMJI PULPA or Pulp of Tamarinds of the Pharmacopoeia. 



8. PRUNUM— PRUNES. 

Prunes are the dried fruit of Prunus domestica, Plum-tree ; Sex. 
Syst. Icosandria Monogynia ; Nat. Ord. Rosacea? ; which is cultivated 
in temperate regions every where ; but is supposed to be a native of 
Syria, especially near Damascus. The dried fruits are called Prunes or 
French plums. They are chiefly imported from the south of France, and 
are derived from the Saint Julien variety ; the table prunes being ob- 
tained from the larger kinds of plum — as the Saint Catharine and the 
Reine-Claude or green-gage. 

The fresh ripe fruit, according to M. Berard, contains about twenty 
per cent, of solid matter, of which upwards of eleven per cent, is sugar, 
and five gum, — the remainder being constituted of the malic and pectic 



168 SPECIAL CATHARTICS. 

acids, albumen and ligneous fibre. The proportion of sugar is increased 
in the process of drying ; but this matter has not been investigated. 

Prunes are laxative, and when taken in the evening are 'sufficient, 
with many, to cause the evacuation of the bowels on the following 
morning. Generally, they are taken stewed as diet in cases of cos- 
tiveness, or in febrile and other diseases in which it is desirable to 
keep the intestinal canal gently free. The sugar and mucilage, which 
they contain, render them also nutritious. They are sometimes added 
to cathartic infusions and decoctions to improve their taste and increase 
their effect. 

The Pulp of prunes, Pruni Pulpa, is made by softening the prunes 
in the vapour of boiling water, and, having separated the stones, beat- 
ing the remainder in a marble mortar and pressing it through a hair 
sieve. It enters into the composition of the Confectio Sennce. 



9. SINATIS.— MUSTARD. 



The seeds of White mustard, Sinapis alba, unbruised, have been 
long recommended, in the dose of a table-spoonful, in cases of torpor 
of the digestive function. They had almost fallen into disuse, however, 
when Sir John Sinclair — the author of a 4 ' Code of Health and Lon- 
gevity" — published an article in a periodical, strongly recommending 
them to the aged as a means of preserving their health, by stimulating 
the digestive function to greater activity, and at the same time keeping 
the action of the intestinal canal free. They may be taken three or 
four times a day mixed with molasses. It would seem, however, that 
their use in large quantities, in torpid habits, is not totally devoid of 
danger. They have been known to accumulate in the caecum and 
appendix cseci, and are said to have induced fatal inflammation of the 
stomach and bowels. 

Besides the above officinal laxatives, there are some, which are 
occasionally used as such, but whose prominent effects are of a different 
nature. These will require a passing notice. 



10. O'leum amyg'dalj:, Oil of almonds ; and O'leum OLi'viE, Olive 
oil. The properties of these oils are described elsewhere. Both of 
them are mild laxatives in the dose of f.^ss. to f.aj. although not often 
used as such. When prescribed, it is generally in affections of the ali- 
mentary canal, or of the genito- urinary apparatus, when it may be desira- 
ble to give laxatives that will not enter into the blood-vessels, and 
irritate the kidneys or urinary passages. A common laxative for new- 
born children, in England, is a mixture of equal parts of Oil of almonds 
and Syrup of violets, or Syrup of Roses — the dose of which is a tea- 
spoonful ; but olive oil and simple syrup are equally effective. 



OLEUM RICINI. 



169 



II. Purgatives or Brisk Cathartics. 

11. O'LEUM RIC'INL— CASTOR OIL. 

Castor oil plants Ri- Fig. 17. 

cinus communis or Pal- 
ma Christi ; Sex Syst. 
Monoecia Monadelphia ; 
Nat. Ord. Euphorbia- 
ceee, is probably a na- 
tive of the East Indies, 
Greece and Africa, 
whence it was intro- 
duced into the West 
Indies and the Ameri- 
can continent. It is 
now largely cultivated 
in many parts of the 
United States. In In- 
dia, it is said to attain 
the height of fifteen or 
twenty feet ; but in this 
country it does not ex- 
ceed a few feet. The 
seeds ripen successively 
in August and Septem- 
ber. They are of an 
oval shape, somewhat 
compressed, and about 
the size of a small bean. 
Externally they are 
smooth and shining, and 
of a pale grey colour, 
marbled with reddish- 
brown spots and stripes. 
In their general appear- 
ance, they have been 
likened to a tick, whence the name Ricinus. The husk wiiich consti- 
tutes 24 per cent, of the seed, is chiefly composed of ligneous fibre, with 
a little gum, resin, and extractive matter. The nucleus or kernel, which 
has been found to amount to 69 per cent, of the seed when dry, contains 
46.2 of fixed oil, 2.4 of gum, 0.5 of soluble albumen and 20 of coagu- 
lated albumen. The fixed oil is the Oleum Ricini. 

The quantity of castor oil used almost exceeds belief. Of 490, 558 lbs. 
imported into England in 1830, 441,267 lbs., according to Mr. M'Cul- 
loch, were from the East Indies ; 39,408 lbs. from the British Northern 
Colonies of America ; 5,139 lbs. from the United States ; and 4,718 lbs. 
from the British West Indies. A large proportion of that used to the 
east of the Alleghanies comes by way of New Orleans from Illinois and 
the neighbouring States, where it is so abundant as to be sometimes 
burnt in lamps. 




Ricinus Communis. 



a. Stamens, b. Anther, e. Stigmas. 
/. Embryo. 



d. Capsule, e. Seed. 



170 SPECIAL CATHARTICS. 

The mode in which it is prepared in this country is as follows :•— 
The seeds being cleansed from all extraneous matters, are put into a 
shallow iron reservoir, and submitted to a gentle heat, not greater than 
can be readily borne by the hand ; the object of which is, to render the 
oil sufficiently liquid to be easily expressed. They are then introduced 
into a powerful screw-press, by which process a whitish oily liquid is 
obtained, which is transferred to clean iron boilers, supplied with a con- 
siderable quantity of water. The mixture is boiled for some time, and the 
impurities being skimmed off, a clear oil is left on the top of the water, 
the mucilage and starch being dissolved in the water, and the albumen 
coagulated. The clear oil is removed, and the process completed by 
boiling it with a small proportion of water, continuing the application 
of heat till aqueous vapour ceases to rise, and till a small portion of the 
liquid, taken out in a vial, is perfectly transparent when it cools. The 
effect of this last operation is said to be to clarify it, and render it less 
irritating by driving off the acrid volatile matter. If the heat be carried 
too far, the oil acquires a brownish hue, and an acrid taste similar to 
the West India oil. One bushel of good seeds yields five or six quarts, 
or about 25 per cent, of the best oil. (Wood & Bache.) 

The oil, which is obtained by expression without heat, is called cold- 
drawn castor oil. 

Recently prepared castor oil, or oil , as it is often called, is inodorous 
and nearly insipid ; colourless, or of a pale straw colour ; thick, but 
perfectly transparent. It is lighter than water ; grows rancid by keep- 
ing ; thickens, and its colour becomes of a reddish-brown. It has a hot 
nauseous taste ; is completely soluble in absolute alcohol, and in pure 
sulphuric ether, differing, in this respect, from all the ordinary fixed oils, 
except palm oil. Hence, alcohol is recommended in the Edinburgh 
Pharmacopoeia to test its purity. In this country, however, the oil is so 
common, that there is no inducement to adulterate it. It has often been 
examined by the chemist, but the source of its cathartic powers has not 
been discovered. 

Castor oil seeds are possessed of acrid cathartic properties, and are 
said to have proved fatal when taken to the extent of twenty at once. 
The acrid principle is considered to be dissipated by the heat of boiling 
water; but it is more probable that it exists in the covering of the ker- 
nal, inasmuch as the cold-drawn castor oil does not appear to be more 
active than that which is prepared by heat. It has been seen, indeed, 
that long continued heat developes acridity. 

Castor oil is one of the most valuable of the mild cathartics, ope- 
rating by virtue of a special affinity for the mucous membrane of the 
bowels ; for when injected into the veins— as was done by a respectable 
physician of this country, (page 144,) it produced intestinal disorder, 
and what was more surprising, the taste of castor oil was experienced. 
It is one of the most speedy in its operation, and, accordingly, is well 
adapted for all cases in which it is desirable to evacuate rapidly the con- 
tents of the bowels. It is apt, however, to induce nausea and vomiting; 
and this sometimes renders it inapplicable. As elsewhere remarked, its 
cathartic action is not by any means in a ratio with the dose ; hence, in 
cases in which it is merely desired to evacuate gently the bowels a tea- 



RHEUM. 



171 



spoonful or two will often operate as effectually as a larger quantity, 
and, of course, with less probability of exciting nausea. The author is 
constantly in the habit of giving it in tea-spoonful doses, especially where 
there is erethism of the mucous membrane of the bowels; — and the dose 
is generally sufficient. For children, it is unquestionably one of our 
most satisfactory cathartics, and is in constant use in domestic practice, 
— the only objection being its nauseous taste. 

The ordinary dose is considered to be a fluidounce, or about two 
table-spoonfuls ; rarely, however, can more than a table-spoonful be 
needed. For children, the ordinary dose is a tea-spoonful. It is so 
exceedingly disagreeable to many persons, that they can scarcely be 
prevailed upon to take it ; and, under such circumstances, if it reaches 
the stomach, it is apt to be rejected. As in other cases, however, if the 
dose be repeated immediately, it may be retained. To obviate this un- 
pleasant taste, it may be dropped on a little aromatic water, spirit and 
water, hot coffee, or hot milk, and the mouth may be rinsed with some 
of the vehicle before it is swallowed. Dr. R. E. Griffith, of Philadelphia, 
says the most effectual mode of disguising its taste is to mix it with 
the froth of porter. It is not unfrequently made into an emulsion with 
the yolk of egg, or mucilage, and some aromatic water. (01. ricini 
f-3 v j 5 vitell. ovi, seu mucilag. acac, seu mucilag. tragacanth. f.^ss ; 
aqua menthce pip. f.^v. — Dose, a fourth part every two hours until it 
operates.) Oil of turpentine aids its action materially, but renders it still 
more disagreeable. Should it be indicated, two drachms may be added 
to the above mixture. Where nausea and vomiting are anticipated, or 
intestinal irritation exists at the same time, ten drops of laudanum may 
be added to the dose of oil. 



12. RHEUM— RHUBARB. 



Rhubarb is the root of Rheum palmatum and other species of Rheum ; 
Sex. Syst. Enneandria monogynia ; Nat. Ord. Polygonaceae. The 
botanical history of this drug, long and extensively as it has been known 




Rheum Palmatum. Rheum Compactum. 

and employed, is still unsettled. Different varieties have been referred 



172 



SPECIAL CATHARTICS. 




Rheum Emodi. 



to different species of rheum diffused over the Asiatic continent ; yet still 
its pharmacological history is undetermined. 

p . 2Q The chief varieties of rhubarb root met 

with in commerce are the Chinese, Rus- 
sian, and European. Dr. Pereira, how- 
ever, states, that he is acquainted with six 
kinds — the Russian, Dutch-trimmed, Chi- 
nese, Himalayan, English, and French. 

Chinese, or East India Rhubarb, con- 
stitutes the largest portion of that which is 
used in this country. It is brought either 
directly from Canton, or by Singapore and 
other ports of the East Indies. As we 
meet with it, it is either in round or flat- 
tened pieces ; seems smooth, as if it had 
been scraped ; and is generally perforated 
with holes, in many of which are found 
pieces of the cords by which it had been 
suspended. It is more heavy and compact 
than the Russian variety ; the smell, too, is much less powerful, and the 
colour of the powder of a more dull yellow or brownish cast. 

Russian, Turkey, Moscow, Bucharian or Siberian Rhubarb, is 
imported from St. Petersburg ; and is said to have been formerly shipped 
from the Turkish ports, from which it was brought from Tartary by cara- 
vans through Persia and Natolia. Hence, it was often called Turkey 
Rhubarb. The Bucharian merchants have entered into a contract with 
the Russian government to supply it with rhubarb in exchange for furs. 
It is carried by them to Kiachta, a frontier town, where it is inspected 
by a Russian apothecary, employed there for the purpose. The worm- 
eaten portions are rejected, and the others are bored to ascertain their 
soundness. The portions which do not pass examination are burned; 
and the rest is sent on to the Russian capitol. 

The size and shape of the pieces are various, — the external appear- 
ance seeming to show, that the cortical portion had not been scraped as 
in the Chinese Rhubarb, but had been cut off longitudinally by the knife ; 
hence the angular appearance of the surface. The smell and taste are 
essentially those of the Chinese variety, excepting that the latter is 
somewhat more aromatic. The aroma is, however, so delicate, that, 
according to Dr. Pereira, in all wholesale drug houses, a pair of gloves 
is kept in the Russian rhubarb drawer with which to handle the pieces. 
When chewed, both it and the Chinese variety feel gritty under the 
teeth, owing to the presence of numerous crystals of oxalate of lime. 
The colour of the powder is a bright yellow, without the orange tinge of 
the Chinese. 

As the Russian is much more expensive than the Chinese variety, the 
latter is sometimes cut so as to resemble it ; but the fraud may be de- 
tected by attention. Dr. Wood states, that he has seen parcels of very 
good rhubarb imported from Canton, which were evidently prepared so 
as to resemble the Russian ; but in most, if not all, of the pieces which 
came under his notice, the small perforating hole was found, which 



RHEUM. 173 

characterizes the Chinese rhubarb, although in some instances it had 
been filled with the powdered root so as to conceal it. This was pro- 
bably the Dutch-trimmed or Batavian Rhubarb, which, according to 
Dr. Pereira, is imported from Canton and Singapore. Sometimes, the 
worm-eaten pieces are made to resemble the sound by filling up the 
holes with a mixture of powdered rhubarb and mucilage, and covering 
over the surface with the powder; but, by removing this, the fraud is 
detected. 

At times, too, the eastern varieties are mixed with the European, 
which is easily distinguishable by its weaker aroma, and want of gritti- 
ness when chewed. It is not easy, however, to detect the admixture, 
if the rhubarb be in a state of powder, and the adulterating article be in 
small quantity. 

European Rhubarb is much inferior to that which is brought from 
Russia and China. In England two kinds are met with in the shops 
under the name of English Rhubarb ; — one dressed or trimmed, so as to 
resemble the Russian ; the other, sometimes called stick rhubarb. It is 
raised in various parts of England, but chiefly near Banbury in Oxford- 
shire ; and is distinguished from the Asiatic varieties by being exter- 
nally of a reddish hue, and having brownish spots of adhering bark ; 
and internally a looser, softer, spongy texture, with occasional cavities, 
especially in the centre. It is pasty under the pestle. In taste and 
smell, it resembles Asiatic rhubarb ; but is more mucilaginous, and does 
not, like it, feel gritty under the teeth. Stick rhubarb is in irregular 
pieces, about five or six inches long, and an inch thick. Its taste is 
astringent ; but very mucilaginous. Both varieties of English rhubarb 
are said to be extensively employed by druggists to adulterate the 
powder of Asiatic rhubarb. Rhubarb is likewise cultivated largely in 
France, especially at an establishment called Rheumpole, near the port 
of Lorient. 

The quantity of rhubarb consumed is very great. In the year 1831, 
according to Mr. McCulloch, there were imported into England from 
Russia 6,901 lbs. ; from the East Indies, 133,462 lbs. : of this quantity, 
40,124 lbs. were retained for home consumption. 

From July, 1848, to April, 1849, inclusive, Dr. Bailey, inspector of 
drugs at the port of New York, rejected 8,456 lbs. of rhubarb root 
from Canton ; 6,913 lbs. from London ; 545 lbs. from Hamburg ; and 
1075 lbs. from Marseilles. 

The medical virtues of rhubarb are yielded wholly to water and to 
alcohol. It has been repeatedly subjected to chemical analysis, but 
the results have not been of much pharmacological interest. They 
show that it contains a colouring and a bitter principle ; with astringent 
matter, consisting of tannic and gallic acids, to which a portion of its 
medical virtues is referable ; gum, woody fibre, oxalate and phosphate 
of lime, &c. 

Rhubarb is one of the most valuable cathartics, seeming to act upon 
the whole tract of the intestines, and not causing any very copious 
secretion from the lining membrane. It is, consequently, one of the 



174 SPECIAL CATHARTICS. 

mildest of the class. Owing to its containing tannic and gallic acids it 
is somewhat astringent; and the common opinion is, that it is first an 
evacuant of the bowels, and afterwards an astringent. Its bitter prin- 
ciple, too, gives it tonic properties ; and hence, it is prescribed in small 
doses, whenever a joint tonic and laxative agency is needed. Like 
many other cathartics, its operation is often accompanied by tormina, 
which may be obviated by the addition of some aromatic. 

Associated with other cathartics rhubarb forms one of the most com- 
mon prescriptions of the physician. It is often given, especially in 
infancy, combined with magnesia or carbonate of magnesia, which is 
said to remove the constipating influence that rhubarb, given alone, 
exerts after it has acted on the bowels. United with the mild chloride 
of mercury, and an appropriate corrigent, it is an active cathartic, and 
one very commonly prescribed. {Pulv. rhei gr. xv. ; hydrarg. chlorid. 
mit.; pulv. zingib. aa gr. v. M.) By roasting, its cathartic power is 
diminished; and its astringency, it has been supposed, increased; 
hence, it is not unfrequently employed in diarrhoea and dysentery. 

The dose, to produce a full operation, is from twenty to thirty grains; 
in smaller doses, it is laxative. The European varieties require to be 
given in twice the quantity. Its nausea and bitter taste, according to 
Dr. A. T. Thomson, is completely covered, when mixed with milk, if 
the mixture be taken directly ; but the medicine soon communicates its 
taste to the milk. 

When not given in this form, one of the following officinal prepara- 
tions may be prescribed : 

INFUSUM RHEI, INFUSION OF RHUBARB. (Rhei. cont. 5j ; Aquabullient. 
Oss.) The dose of this infusion, as a laxative, is f.±j or f.^ij ; but it 
is rarely given alone. It is commonly used as a vehicle for other 
cathartics or tonics, or for magnesia when prescribed as an antacid. 

PE'ULJ] RHEI, PELS OF RHUBARB. {Rhei pulv. Jij ; sapon. 31J ; divide 
in pil. cxx.) Generally taken at bedtime as a laxative. Dose ; two or 
three, repeated on the following morning if necessary. 

_ mmM RHEI COMPOS IT M, COMPOUND PELS OF RHUBARB. (Rhei pulv. 
|j ; Aloes pulv. 3vj ; Myrrh, pulv. ^ss ; ol. menth . piperit. f.3ss ; Syrup, 
aurant. q. s. ut fiant pil. cclx.) The aloes adds to the activity of the 
rhubarb ; but it is not easy to see what can be the effect of the myrrh ; 
the oil of peppermint is a corrigent, which prevents the cathartics from 
griping. It is a good laxative pill, in the dose of two to four at bedtime. 

SYRU PUS RH I, SYRUP OF RHUBARB. (Rhei contus. § i j ; Aqua bullient. 
Oj ; Sacchar. Eij ; made into a syrup.) Given in the dose of a tea-spoon- 
ful or two to infants as a laxative. It is not so frequently adminis- 
tered, however, as the following: 

SYRUPUS RHEI AROMATICUS, AROMATIC SYRUP OF RHURARB. (Rhei contus. 
§iiss; Caryophyll. contus.; Cinnam. contus. aa |ss ; Myristic. cont. 
3ij ; Alcohol, dilut. Oij ; Syrup. Ovj, made into a syrup. It may be 



ALOE. 175 

prepared also by the process of displacement. — See the Pharmacopoeia 
of the United States, 1842.) This is much used in domestic practice, 
under the name of spiced syrup of rhubarb, in the bowel affections of 
children ; especially in those that occur during the summer and autumnal 
months. The aromatics and the alcohol impart excitant properties to it, 
and render it carminative and laxative. The dose for an infant is a tea- 
spoonful or two. 

TINCTURA MEI, TINCTURE OF RHUBARB. (Rhei cont. |uj ; Cardam. 
cont. §ss ; Alcohol, ciilut. Oij. It may be prepared also by the process 
of displacement.) The cardamoms are added as a corrigent. In the 
dose of f.^ss to f . § j it proves cathartic. In lesser doses, it is some- 
times taken as a stomachic and laxative. 

TINCTURA RHEI ET ALOES, TINCTURE OF RHUBARB AND ALOES. {Rhei cont. 
3x ; Aloes pulv. 3 v j 5 Cardam. cont. 5ss; Alcohol, dilut. Oij.) This 
is the relic of the ancient Elixir sacrum. It combines the cathartic 
virtues of rhubarb and aloes. The dose, as a cathartic, is from f.§ss 
tof.gj. 

TINCTURA RHEI ET GENTIANS, TINCTURE OF RHUBARB AND GENTIAN. {Rhei 
ont. 5ij ; Gentian, cont. 5ss ; Alcohol, dilut. Oij. It may also be made 
by ihe process of displacement.) Combining the tonic virtues of gen- 
tian with rhubarb, this tincture is employed as a tonic and laxative, in 
doses of from f.31 to f.5ss; in larger doses — f.5i to f.iij — it is cathartic. 

TINCTURA RHEI ET SENN$, TINCTURE OF RHUBARB AND SENNA. {Rhei cont. 
^j ; Sennas gij ; Coriandr. cont. ; Fcenicul. cont. aa 3j ; Santal. rasur. 
3'j ; Croci, Glycyrrhiz. aa 3.s s 5 Uvar passar. demptis acinis, £$ss ; 
Alcohol, dilut. Oiij.) This polypharmacal production is an imitation of 
Warner'* s Gout Cordial. The rhubarb and senna are cathartics ; the 
coriander and fennelseed excitants, and therefore corrigents ; the red 
saunders and saffron are mere colouring matters ; the liquorice and 
raisins communicate sweetness to the tincture. It is an agreeable 
stomachic and laxative, especially in the flatulence of the gouty, and 
such as have been addicted to the use of wine or spirituous liquors. 
The dose is f.^ss to f.?ij. 

TINUl RHEI, WINE OF RHUBARB. {Rhei contus. gij ; Canellse contus. 
3j ; Alcohol, dilut. f.|ij ; Vini Oj.) Canella is an excitant and corri- 
gent ; and the wine is applicable to the same cases as the Tinctura 
Rhei. The dose is from f.3iij to f.5j. 

13. AL'OE.— AL'OES. 

Aloes is the inspissated juice of the leaves of Aloe, spicata, and 
other species of aloe ; Sex. Syst. Hexandria Monogynia ; Nat. Order, 
Liliaceae. The London Pharmacopoeia refers it to Aloe spicata 
alone; the United States Pharmacopoeia (1842), with more propriety, 



176 



SPECIAL CATHARTICS. 




Various species of Aloes. 



Fig. 22. 



Fig. 21. to that as well as to other species. It is 

generally believed, indeed, that three 
species furnish the different kinds in the 
market, — Aloe spicata, A. vulgaris, and 
A. Socotorina; and it is considered pro- 
bable, that at least two other species are 
employed, — #. Comelini of Willdenow, 
and A. linguasformis of Thunberg. 

The information, which we possess as 
to the sources of aloes, is still imprecise. 
Within a few years, the drug has been 
imported into England from Bombay, 
Arabia, Socotora, Madagascar, the Cape 
of Good Hope, the Levant, and the 
West Indies, and it would seem, that 
the aloes of British commerce is derived 
more or less from most, if not all of 
those places, directly or indirectly. 
The finest aloes is obtained by inspissating the juice, which flows 

spontaneously from transverse incisions 
made in the leaves. If pressure be used, 
the juice becomes mixed with the mucila- 
ginous liquids of the leaves, and an in- 
ferior kind of aloes is the result. A still 
inferior kind is prepared by boiling the 
leaves, after the juice has escaped, in 
water. 

In England, no less than seven varie- 
ties of aloes are met with — Socotrine, 
Hepatic, Barbadoes, Cape, Mocha, Cabal- 
line, and Indian, (Pereira.) In this coun- 
try, we rarely see more than three, the 
Socotrine, the Cape of Good Hope, and 
the Hepatic. (Wood and Bache.) 

Socotrine Aloes ought to be obtained 
from the Island of Socotora, in the Straits 
I of Babelmandeb, but much that is sold 
under that name is procured from other 
places. It would appear that in 1833 the 
quantity exported from that island was 
two tons. The epithet Socotrine is often 
given to the best specimens of aloes, no 
matter whence obtained. Both in Spain 
and the West Indies, according to Wood 
and Bache, the juice, inspissated in the 
sun, bears this name. It would appear, 
however, that the commercial value of 
the real Socotrine aloes is now below that 
of Barbadoes aloes, than which it is per- 
haps inferior in activity. 




Aloe Socotorina 



ALOE. 177 

Socotrine aloes is of a yellowish or reddish-brown colour, which 
becomes deepened by exposure to air. The fracture is smooth, glassy, 
conchoidal ; yet, even when of excellent quality, it often breaks with a 
roughish, fracture. The powder is of a golden yellow colour. The 
odour of fresh broken pieces, especially when breathed on, is fragrant 
according to some ; it is certainly peculiar, and perhaps, to the mass, 
not unpleasant. The taste, like that of all aloes, is intensely and 
enduringly bitter; but perhaps it is somewhat less disagreeable than 
the other varieties. 

Cape of Good Hope Aloes, or Cape Aloes is imported into Great 
Britain, as its name shows, from the Cape of Good Hope, whence it is 
again imported into the United States. It is the variety chiefly used in 
this country. It differs materially in its appearance from the Socotrine 
aloes, having a shining resinous aspect, whence its name Aloe lucida 
with the German pharmacologists. It is of a deep-brown colour, 
approaching to black, and has a glossy or resinous fracture. When 
held up to the light its edges appear translucent, and have a yellowish- 
red or ruby colour. The powder is of a greenish-yellow colour. Its 
odour is stronger and more disagreeable than that of the preceding 
variety. 

Hepatic or Barbadoes Aloes is imported from Barbadoes or 
Jamaica in gourds. Its colour varies from a dark-brown or black 
to a reddish-brown or liver colour. The fracture is sometimes dull ; 
at others, glossy. The powder is of a dull olive-yellow colour. The 
odour, especially when breathed upon, is exceedingly disagreeable and 
nauseous. It is known that this variety is obtained from Aloe vul- 
garis. It is but little used in this country, except for horses. 

-A variety of aloes, called Genuine Hepatic Aloes, Liver-coloured 
Socotrine Aloes, is exported from Bombay, and would appear to be an 
inferior variety of the Socotrine. The two are sometimes inter- 
mixed. 

The composition of aloes has been investigated by many distinguished 
chemists, TrommsdorfT, Bouillon-Lagrange, Vogel, Braconnot, Wink- 
ler, and E. Robiquet. It was for a considerable period regarded as a 
gum-resin ; but it is questionable, whether it contain strictly either gum 
or resin. Its most important constituent is a bitter extractive matter, 
termed aloesin, which, according to TrommsdorfT, forms 75 per cent, of 
Socotrine aloes, and 81.25 of Barbadoes aloes. Some specimens of the 
latter did not, however, contain more than 52 per cent. There is, in 
addition to this, a resinoid substance, the proportion of which varies 
from 6.25 to 42 per cent. — which has been considered oxidized extrac- 
tive. The most important point, in a pharmacological point of view, 
is, that it yields its medical virtues to cold water ; a dark-brown sub- 
stance, however, being left, which is dissolved by boiling water, but is 
deposited again as the water cools. This is the resinoid substance. Its 
best solvent is dilute alcohol. 

Aloes is more extensively used perhaps than any other vegetable ca- 
thartic. It forms the basis of most cathartic pills. Its action appears 

Vol. I.— 12 



178 SPECIAL CATHARTICS. 

to be exerted on every portion of the canal, but especially on the large 
intestines. Even when placed in contact with an abraded surface, it 
exerts its effect on the bowels ; affording an example of that special 
affinity between particular therapeutical agents and particular portions 
of the economy of which we have so many examples. In large doses 
it is apt to irritate the rectum; and is therefore improper for those who 
are suffering under piles, and in pregnancy. When, however, it is as- 
sociated with hyoscyamus, its injurious agency, in the latter condition 
especially, is obviated. (Jiloes pulv. 3j ; Ext. hyoscyam. 9j.— M. et 
divide in pilulas xx. — Dose, two at bedtime.) 

In its operation, aloes does not stimulate greatly the cutaneous exha- 
Iants, and hence the evacuations are not as watery as those produced 
by many other cathartics. It is rarely, however, given alone ; being 
usually associated with other cathartics, and with some essential oil or 
other excitant, to prevent the griping, which it is apt to occasion. It is 
affirmed, too, that certain substances, although not possessed of any 
cathartic property, increase the cathartic action of aloes. Several ve- 
getable bitters, especially sulphate of quinia, and likewise sulphate of 
iron, have been considered to act in this manner. Dr. Christison states, 
that he has not been able to detect the property in sulphate of quinia ; 
but that it is undoubtedly possessed by sulphate of iron, — one grain of 
aloes with two or three grains of that salt producing as much effect as 
two or three grains of aloes alone, and with much less tendency to irri- 
tate the rectum. The attention of the author has been drawn to this 
point, but he is not able to speak so positively as Dr. Christison. It can 
be understood, however, that any tonic combined with a laxative may 
have the effect of aiding the operation of the latter by the greater energy 
it communicates to the digestive operations. 

The bitter extractive of aloes renders it at the same time tonic ; and 
hence its usual association with tonics, in " dinner pills" when it is ad- 
visable to have a joint tonic and laxative action. 

Aloes is rarely given where a speedy action on the canal is needed. 
Its operation is gradual ; and hence, as well as by reason of its exceed- 
ingly nauseous taste, it is generally prescribed in the form of pill. Its 
action is by no means in proportion to the dose ; and, accordingly, 
it may be administered with impunity even to children in very large 
doses. The author was first induced to employ aloes in such doses by 
the very high eulogiums he had heard pronounced upon it by Dr. Ham- 
ilton, late Professor of Midwifery in the University of Edinburgh, to 
whom the idea of administering it freely in diseases of children was 
suggested, by observing, in an apothecary's shop, where he had been 
placed by his father for the purpose of being practically instructed in 
Pharmacy, that the Syrup of buckthorn — so called — which they were in 
the habit of vending to mothers of families to be given to their children, 
was usually formed extemporaneously of aloes dissolved in treacle or 
molasses ; and upon making inquiries of those who had purchased it, 
he found that no bad effects had resulted from its administration ; he, 
consequently, formed the determination of trying it in his own practice, 
when he found it to be not only a successful agent after other means 
had failed, but also, that it was rarely rejected by the stomach, acted 



ALOE. 179 

mildly, was perfectly safe, and but seldom objected to by young infants. 
The author has elsewhere detailed cases in his own practice, as well as 
in that of others, in which two drachms of powdered aloes were taken 
in this form in two successive days, without any griping or unpleasant 
symptom, and with full relief to the constipation. [Commentaries on 
Diseases of the Stomach and Bowels of Children, p. 92, Lond. 1824.) 
The dose of aloes, as a purgative, is from five to ten grains or more; 
as a laxative, two or three grains, in the form of pill. 

PIL'ULE AL'OES, ALOET'IC PILLS.— (.tf/oes pulv., Sapon. aa 3ij. Divide 
in pil. ccxl.) The soap is added with the view of assisting the solu- 
tion of the aloes, so as to cause it to act on the whole intestinal tract, 
rather than on the rectum. Five pills contain ten grains of aloes ; so 
that two at bedtime usually produce a laxative effect on. the following 
day. 

PILULE ALOES ET ASSAF(E'TD)J1, PELS OF AL'OES AM) ASSAFET'M.-(^/oes 
pulv., Jlssafcetid., Saponis, aa |ss; divide in pilulas clxxx.) The as- 
safetida is added as an excitant ; and the pill is given in constipation 
accompanied by flatulence, and impaired tone of the stomach and intes- 
tines. Dose, two to five. 

PILULE AL'OES ET MYRRHS, PELLS OF AL'OES AWL Mm.— (Moes 
pulv. 3ij ; Myrrh, pulv. 3j ; Croci 3ss ; Syrup, q. s. ut fiant pil. 
cccclxxx.) These are the old Pilulas Rufi or Rufus^s pills. They are 
frequently used by females labouring under catamenial obstruction, 
which is generally attended by more or less, atony and constipation ; 
the myrrh being regarded as an emmenagogue. The dose is from three 
to six. 

PULVIS AL'OES ET CANEL'LJl, POWDER OF AL'OES AND CANELLA.— (Aloes 
f$j ; Canellas £iij.) This is the old Hiera picraoi " holy bitter ," which 
has long been much used in domestic practice as an emmenagogue. 
The canella is excitant, and therefore prevents the griping tendency of 
the aloes ; but, like the last preparation, this is no more emmenagogue 
than any of the other combinations of aloes ; all of which — as else- 
where remarked — affect the uterus only by contiguous sympathy, 
through their action on the lower part of the intestinal canal. 

TINCTU'RA ALOES, TINCTURE OF ALOES.— (Moes pulv. §j ; Glycyrrhiz. 
3iij ; Alcohol. Oss; Jiq. destillat. Oiss.) The same objection applies 
to the tincture of aloes as to the powder, and indeed to every form of 
administration except the pill. It is in the highest degree nauseous, 
and the liquorice renders it scarcely less so. Its dose, as a cathartic, 
is from f.^ss to f.^iss. 

TINCTU'RA ALOES ET MYRRH1, TINCTURE OF ALOES AND MYRRH.— {Aloes 
pulv. §iij ; Croci §j ; Tinct. Myrrh. Oij.) This is a relic of the Elixir 
Proprietatis of Paracelsus. It possesses the same medical properties 



180 



SPECIAL CATHARTICS. 



as the Pilulae Aloes et Myrrhs,— the saffron being a mere colouring in- 
gredient. Its dose is from f-5j to f.3\j or more. 

* 
MM ALOES, WINE OF ALOES.— (Moes pulv. §j ; Cardam. cont. ; 
Zineib. cont. aa 3j ; Vini Oj.) Wine of aloes is used in the same cases 
as the tincture ;— the cardamom and ginger acting as corngents. 

Aloes likewise enters into other officinal formula?, as Extractum Co- 

locynthidis compo~ 
Fig. 23. situm ; Pilulse Rhei 

composite, Tinctu- 
ra Benzoini compo- 
sita, and Tinctura 
Rhei et Aloes — 
which are described 
elsewhere. 




14. SENNA. 

In the Pharma- 
copoeia of the Uni- 
ted States (1842), 
Senna is defined to 
be "the leaflets of 
Cassia acutifolia 
(Delile), Cassia ob- 
ovata (De Candolle) and Cassia elongata (Lemaire Journ. de Pharm., 

vii. 345)." These plants belong, 



Cassia lanceolata. 
1. Separated flowers. 2. Seed. 3. Legume. 



Fig: 24. 




Cassia acutifolia. 
a. Detached flower. 



in the Sexual System, to Decan- 
dria Monogynia ; Nat. Ord. Le- 
guminosse. Confusion, however, 
still exists as to the precise species 
that yield the senna leaves of com- 
merce. Cassia lanceolata and C. 
JEthiopica appear to furnish part. 
The leaflets of Cassia obovata, 
which is a native of Egypt, Nubia, 
Syria, India, &c, and has been 
cultivated in Italy, Spain, and the 
West Indies, are said to form 
Aleppo, Senegal and Italic 
Senna, and to be one of the con- 
stituents of Alexandrian senna. 
Those of Cassia acutifolia, which 
is a native of Egypt, in the val- 
leys of the desert to the south and 
east of Assouan, are collected by 
the Arabs, and sold to the mer- 
chants, who convey it to Cairo. 
This is said to be the species that 



SENNA. 



181 



furnishes the Tripoli Senna, and the greater part of the variety, known 
in commerce under the name of Alexandrian Senna. Dr. Pereira, 
however, refers the Tripoli stnna, which he thinks he has detected in 
Alexandrian senna, to Cassia JEthiopica, which grows in Nubia, Fez- 
zan to the south of Tripoli, and probably in Ethiopia. 

The leaflets of Cassia elongata, which grows in India, are said to yield 
Tinnevelly and Mecca Sennas. 

The consumption of senna is considerable. The quantity on which 
duty was paid in England, in 1838 and 1839 was, accordingto Dr. Pereira, 
as follows ; from the East Indies, in 1838, 72,576 lbs. ; in 1839, 110,409 
lbs. ; from other places, in 1838, 69,538 lbs. ; in 1839, 63,766 lbs. 
The Mediterranean Senna is brought chiefly to this country from Mar- 
seilles ; the Indian variety comes either from Bombay or Calcutta, — 
directly, or by the way of London, where it is purchased at the East In- 
dia Company's sales. 



Fig. 25. 



Fig. 26. 




Legume and leaflet of Acute leaved 
Alexandria Senna. 



who resell it. 



Legume and leaflet of C 
obovata. (Pereira.) 




(Wood & Bache.) 

The varieties that 
are brought to this 
country are the Alex- 
andrian, Tripoli, and 
Indian. 

Alexandrian Sen- 
na is an admixture of 
the leaflets of the spe- 
cies of cassia referred 
to in the Pharmaco- 
poeia of the United 
States. It is sold by 
compulsion to the 
Egyptian government, 
It is collected in Nubia and upper Egypt, and is sent 
down the Nile to the great depot of Boula, 
near Cairo. It is of a greyish green colour ; 
of a smell resembling that of tea, and of a 
viscid taste. It has a broken appearance, and 
contains various extraneous matters, which are 
separated from it, — when it becomes what is 
termed picked Alexandrian senna. 

Tripoli Senna resembles, in appearance, 
the Alexandrian, than which it is much cheap- 
er. It is more broken up, however; and, al- 
though very active, is less esteemed. It con- 
sists of the leaves of Cassia JEthiopica, and 
is carried from Fezzan, where it grows, to 
Tripoli. 

Of the Indian or Mocha Senna, there are 
two varieties; 1, the Tinnevelly Senna, or 
the finest East Indian Senna, which is culti- 



Tinnevelly Senna. 



a. Legume, b. Leaflet. (Royle.) _,. n • ,i ' *. «f 

vated at Tinnevelly in the southern part ot 
India. It is a fine unmixed senna, is extensively employed, and brings 



182 SPECIAL CATHARTICS. 

a good price. It consists of large unbroken leaflets, of a fine green 
colour, from one to two inches or more long, and at times half an inch 
broad at their widest part. 2. An inferior or second East Indian sen- 
na, the Mecca Senna, or Pike Senna, which is cultivated in Arabia, 
and finds its way to Bombay. It is in long leaflets, narrower than those 
of Tinnevelly senna, and of a yellowish colour, some of the leaflets 
being brownish or even blackish, and is occasionally mixed with pods, 
and with stalks and dust. Different adulterations of senna have been 
pointed out by pharmacological writers, but they do not appear to apply 
to the sennas of this country, which are generally sufficiently pure. It 
is proper to remark, however, that Dr. Bailey, inspector of drugs at the 
port of New York, from July, 1848, to April, 1849, inclusive, rejected 
1,400 lbs. of Senna from Leghorn, and 4,894 lbs. from London. 

Senna yields its virtues to water — warm or cold ; and to alcohol— pure 
or dilute ; hence, water and dilute alcohol are the menstrua employed in 
officinal preparations. It has, 1, an odorous principle — volatile oil of 
senna — which of course is lost by boiling. This has a nauseous odour 
and taste ; and appears to possess some cathartic power, — the distilled 
water acting as a mild cathartic : — 2, a bitter principle, to which the 
name catharlin has been given. According to Dr. Pereira, three grains 
of this cause nausea, griping and purging ; but it is denied by Dr. Christi- 
son and others, that this is the cathartic constituent. 

The active principle is precipitated by infusion of galls, and proba- 
bly by other astringents, as well as by a solution of subacetate of lead ; 
but these substances can scarcely be combined in the same prescription. 

Senna has a special affinity for the lining membrane of the intestines; 
for its infusion proves cathartic when injected into the veins ; and the 
infant at the breast is purged by it, after the mother has taken it ; hence 
it must have passed into the circulation of the latter. It may, therefore, 
operate both by direct contact, and indirectly through the circulation. 
It is a safe, active, and rapid cathartic ; hence its value, alone, or as- 
sociated with other articles, that act speedily, where such action is de- 
sirable. The objection to it is its nauseous taste, and tendency to 
induce vomiting, and especially griping. The corrigents, generally 
used to obviate these objectionable qualities, are aromatics and saccha- 
rine matters, which last have been considered the best of all. They 
appear, too, to be modified by combining it with certain other cathar- 
tics. Like others, too, its purgative effect seems to be increased by 
combination with a tonic ; yet the combination is rarely necessary; and 
therefore not often made, on account of the disagreeable character of 
the compound. 

Senna is rarely given in powder, partly by reason of the quantity ne- 
cessary to produce the effect. From 3ss to 3ij is the average dose. 
Black tea and coffee have been advised to cover its disagreeable 
flavour. 

INFU'SUM SENNJE, INFUSION OF SENNA.— (Sennx § i j ; Coriandr. cont. |j ; 
Aquae bullient. Oj.) The coriander is added as a corrigent. Senna tea 
sweetened with sugar is a common domestic remedy, especially as a 
purgative for children. It is most frequently used as a vehicle 



CASSIA MAMLANDICA. 183 

for other cathartics, of the saline class, especially. The well known 
Haustus niger or black draught or black dose — the terror of the 
invalid, by reason of its nauseous character — is a compound of this 
nature. It may be made as follows: — Infus. Sennas f.§v; aq. cinnam. 
f.5j ; mannas 3iv. magnes. sulphat. 3vj. Dose, an ounce and a half or 
more. The dose of Infusum Sennas is f.§iv. 

According to Dr. A. T. Thomson, the disagreeable taste of senna is 
less when the infusion is made with cold 'water, although it does not 
lessen the activity of the drug. The taste of the ordinary infusion of 
senna is covered by the addition of a few grains of cream of tartar, or 
by admixture with black tea. 

TINCTU'RA SENNjE ET JAM? J, TINCTURE OF SENNA AND JALAP.— (Senna 
5iij ; jalap, pulv. 3jj ; coriandr. cont:; carui cont. aa 3ss ; cardamom. 
cont. 3U I sacchar. 5iv ; alcohol, dilut. Oiij. It may be made also 
by the process of displacement.) This is one form of the old elixir 
salutis. The jalap is a cathartic adjuvant; the aromatics, saccharine 
matter, and the menstruum itself act as corrigents. It is a carminative 
cathartic, and is employed occasionally, like tincture of rhubarb, in cos- 
tiveness attended with flatulence, especially in persons of the gouty 
diathesis. It is more commonly used, however, as an adjunct and 
adjuvant to infusion of senna. Its dose, as a cathartic, is from f.§ss 
to f.Jj. 

SYRU'PUS SENNJ3, SYRUP OF SENNA. {Senna Jij ; Farnic. cont. gj ; aqua 
bullient. Oj ; sacchar. 3xv.) The syrup of senna may be added to the 
infusion, as an adjuvant and corrigent. It is well adapted, also, as a 
cathartic for children. Dose, f.3j to f.giij. 

CONFEC'TIO SEMI, CONFECTION OF SENNA. (Senna Iviij ; coriandr. giv ; 
glycyrrhiz. cont. giij ; Fie. £gj ; pulp. prun. ; pulp, tamarind. ; pulp, 
cassia Jistul. aa fgss ; sacchar. f$iiss ; aqua Oiv. Make into an elec- 
tuary.) This is one of the forms of the lenitive electuary, long used as 
a laxative, especially by pregnant females, in affections of the rectum, 
and whenever a gentle effect on the bowels is needed. The coriander 
and saccharine matters act as corrigents to the senna ; whilst the liquo- 
rice, figs, prunes, tamarinds, and pulp of cassia are, at the same time, 
laxative. The dose is from 3ij to 3iv, taken at bed-time. 

Senna likewise enters into other officinal preparations, as tinctura 
rhei et senna, and syrupus rhei et senna of the Pharmacopoeia of the 
United States. 



15. CAS'SIA MARILAN'DICA.— AMER'ICAN SENNA. 

This is an indigenous perennial plant, Sex. Syst. Decandria Mono- 
gynia,; Nat. Ord. Leguminosse, from three to six feet high, with flowers 
of a beautiful golden yellow colour, which is very common in every part 
of the United States to the south of New York, growing most abun- 



184 



SPECIAL CATHARTICS. 



Fig. 28. 



dantly in flat ground on the margins of rivers and ponds It is some- 
times cultivated in the 
gardens for medical use. 
The leaves of wild 
senna — as it is often 
termed — are collected 
in August or the begin- 
ning of September, and 
carefully dried. It is in 
full bloom in the months 
of July and August. 

-Jn the shops of this 
country, the leaves are 
often met with in com- 
pressed cakes, prepared 
by the Shakers. They 
have a feeble smell, and 
a disagreeable taste, 
somewhat resembling 
that of senna ; would 
appear to contain an ac- 
tive principle, similar 
to the cathartin of sen- 
na ; and yield their vir- 
tues to both water and 
alcohol. 

The medical virtues 
of American senna are 
similar to those of the 
imported article; but it 
is not so active, requir- 
ing to be given in a 
dose about one-third 
larger. It may be pre- 
scribed, like senna, in 
the form of infusion. 




Cassia Marilandica. 



16. JUGLANS.— BUTTERNUT. 

. Butternut is the inner bark of the root of Juglans cinerea, an indige- 
nous forest tree known not only under the name of butternut, but also 
of oilnut, and white walnut ; Sex. Syst. Moncecia Polyandria ; Nat. 
Ord. Terebinthacese ; — Juglandese, (Lindley.) It grows in the Canadas, 
and in the northern, eastern, and western parts of the United States ; 
flowering in May, and the fruit ripening in September. The inner bark 
of the root, which is the officinal portion, is collected in May or June. 

It is a gentle cathartic, resembling rhubarb in its operation, an4 was 
much used in the array of the United States during the revolutionary 
war. It is rarely, however, prescribed in the cities. It yields its virtue 
to water, and may be given either in the form of decoction or of extract. 



PODOPHYLLUM. 



185 



The latter is officinal. Juglans itself is rarely if ever prescribed in 
substance. 

EXTRACTUM JUGLAN'DIS, EXTRACT OF BUTTERNUT. (Prepared by evapo- 
rating the decoction of the inner bark of the root in coarse powder, or 
by the process of displacement.) 

The extract often found in the shops is prepared, by the country peo- 
ple, from a decoction of the bark of the branches ; and, it is said, even 
from the branches themselves. This, it has been suggested, may 
account for the uncertainty of its action. The dose is 20 or 30 grains. 



17. PODOPHYLLUM.— MAY APPLE. 

Podophyllum, of the Pharmacopoeia of the United States, is the rhi- 
zoma of Podophyllum 
peltatum ; Sex. Syst. 
Polyandria Monogynia ; 
Nat. Ord. Ranuncu- 

laceae ; Podophylleae, 

(Jussieu), Berberidaceae, 
(Torrey $* Gray); an in- 
digenous herbaceous 
plant, growing exten- 
sively through the U. 
States, in moist shady 
places, and low marshy 
grounds, and commonly 
known under the name 
of May apple or Man- 
drake. It flowers about 
the end of May or the 
beginning of June ; and 
the fruit, which is some- 
times preserved, ripens 
in the latter part of Sep- 
tember. The root is col- 
lected after the leaves 
have fallen off. As met 
with in the shops, it is 
in pieces about two lines 
thick, with broad flat- 
tened joints at short in- 
tervals ; is Wrinkled Ion- Podophyllum Peltatum. 

gitudinally, and of a reddish or yellowish-brown colour externally. 
Internally, it is of a whitish colour. Its taste is at first sweetish ; after- 
wards bitter, nauseous, and slightly acrid. It yields its virtues both to 
water and alcohol. 

The powdered root resembles jalap in its action, and may be used in 
the same cases and forms of combination. Its dose is about 20 grains. 




186 SPECIAL CATHARTICS. 

EXTRACTS PODOPHYL'LI, EXTRACT OF MAT APPLE. (This extract is 
directed to be prepared in the same manner as the Extractum Jalapse, 
for which it might be substituted.) Its dose as a cathartic is from five 
to fifteen grains ; but neither it nor podophyllum is much used by the 
profession generally. 

• 18. HYDRAR'GYRI CHLO'RIDUM MITE.— MILD CHLORIDE OF MER'CURY. 

Mild Chloride or Subchloride of Mercury, Submuriate of Mercury 
or Calomel is usually prepared by sublimation. According to the Phar- 
macopoeia of the United States, a sulphate of mercury is first formed by 
boiling two pounds of mercury in three pounds of sulphuric acid, until 
the salt is left dry. This is then rubbed, when cold, with the remainder 
of the mercury, until they are thoroughly mixed. A pound and a half 
of chloride of sodium is now rubbed with the other ingredients till all 
the globules disappear. The mild chloride is then sublimed, and after- 
wards reduced to powder, and washed frequently with boiling distilled 
water, till the washings afford no precipitate upon the addition of solu- 
tion of ammonia. If no metallic mercury were added in this process, 
the sublimate would be corrosive chloride. As prepared in this way, 
there is always some corrosive chloride mixed with the mild chloride, 
which is removed by the washing directed in the process. With the same 
view, and to obtain it in a state of minute division, the mild chloride in 
vapour is, at times, made to come in contact with steam in the sub- 
liming vessel by which it is condensed. 

Calomel is also occasionally made by precipitation from a solution of 
mercury in nitric acid, as much as possible in the state of protoxide, 
and adding to it chloride of sodium. By this process, it is obtained in 
a state of very fine division. 

When well prepared, the two calomels are essentially alike in thera- 
peutical properties ; but the one by sublimation is generally preferred. 
Neither one nor the other is made by the apothecary, but by the manu- 
facturing chemist on a large scale. That which is prepared in the ordi- 
nary mode by sublimation, forms a crystalline cake, the shape of which 
is dependent upon that of the subliming vessel. The crystals are square 
prisms. As seen, however, in the shops, it is in fine powder, devoid of 
taste and smell, and of a light bufT colour. That, which results from 
the vapour condensed by steam is perfectly white. It is wholly vola- 
tilized by heat, and is insoluble in water, alcohol and ether. By expo- 
sure to light it becomes darker coloured, and hence ought to be kept in 
a bottle coated with black paper, or painted black. By the alkalies or 
alkaline earths, it is immediately blackened, owing to the formation of 
protoxide of mercury. Should it contain corrosive chloride ; when dis- 
tilled water is boiled with it, a white precipitate will be caused on the 
addition of ammonia. 

Mild chloride of mercury is in much use as a cathartic, and perhaps 
nowhere more than in the United States. It has been elsewhere re- 
marked, that it is one of the cathartics that do not act in a direct ratio 



HYDRARGYRI CHLORIDUM MITE. 187 

with the dose ; indeed, it often happens, that whilst three or four grains 
operate freely, twenty or thirty may exert but little agency. In the 
latter quantity it has been advised to allay irritability of the stomach or 
bowels in numerous diseases, and especially in spasmodic cholera, in 
which it has been prescribed in enormous quantities by some, under 
the idea that large doses act as a sedative. Yet this sedative influence 
— if it exist — must be confined within certain limits, otherwise the im- 
mense doses occasionally given — amounting even to drachms — ought 
to be attended with disastrous consequences. It has been already 
shown, that, according to the idea of Rasori, all cathartics act best in 
moderate doses ; and that when they are given beyond a certain amount 
they prove sedative rather than cathartic. 

Calomel is essentially a cholagogue cathartic, acting upon the upper 
part of the intestines more especially, and by contiguous sympathy upon 
the liver ; hence its operation is often attended with a copious discharge 
of bile, which — as already remarked — may be no evidence that the 
individual is bilious, but merely that he has taken a cathartic,- which 
acts upon the lining membrane of the duodenum, and thus augments 
the biliary secretion. The source of the green stools, calomel stools, which 
succeed to its repeated employment, has been a subject of difference of 
opinion : they appear to be owing to a modified secretion of the whole 
glandular and follicular apparatus connected with the intestinal canal, 
which it certainly excites to greater action. 

With many persons — perhaps with most — when taken to the extent 
of inducing purging, calomel causes more or less nausea, and at times 
vomiting ; and not unfrequently its action is accompanied by griping. 
Notwithstanding these inconveniences, however, it is an excellent 
cathartic, especially when taken at night in the form of pill, and followed 
up by some saline or other cathartic, of more general and speedy action, 
on the following morning- It is an excellent adjunct to other cathar- 
tics ; and hence — where there is no special objection to its employ- 
ment — it is a common and effective ingredient in most active cathartic 
pills. It is also a very common cathartic for children in consequence 
of the facility with which it can be administered. The only objection 
to it is, that in habits which are very impressible to the action of mer- 
cury, it is apt to affect the mouth, even when every precaution has been 
taken; and, in children especially, to induce stomatitis, with fcetor of 
the breath, increased flow of saliva, troublesome ulcerations, and, in 
rare cases, sloughing of the gums and cheeks, and even necrosis of the 
bones of the face. It is proper, however, to remark, that the author 
has noticed some cases in which these phenomena presented themselves 
where no mercury had been taken. Still, it must be admitted, that 
where a disposition exists to such stomatitis, it may be developed by 
the use of a calomel purge. Particular persons are unusually suscep- 
tible to mercury, and have the constitutional phenomena, pointed out 
elsewhere, induced by a very small quantity of it; and in public prac- 
tice the author has remarked, that at certain seasons or periods almost 
every patient in the wards of the hospital could be affected with mercury 
by the exhibition of a pill of a few grains of calomel, or even of the 
pilulse hydrargyri. This disagreeable result is less to be apprehended 



188 SPECIAL CATHARTICS. 

under the age of two years,— children at that early age resisting the 
action of mercury, to which they are so susceptible at an after period. 

Associated with opium, calomel is a valuable agent in many intes- 
tinal affections accompanied with constipation, or in which it is desir- 
able to gently excite the action of the canal, to remove scybala or irri- 
tating matters ; for example, in various species of colic, and in enteritis 
after blood-letting, — the opium acting as a sedative in the dose of two or 
three grains, and the same amount of calomel associated with it, then 
operating as a cathartic, — and in diarrhoea, dysentery, &c. As a cathartic 
calomel is often employed in cases of worms, and appears to act not 
simply by dislodging the parasites, but by proving, in some measure, 
anthelmintic. 

In Great Britain, the ordinary dose of calomel as a cathartic is from 
two to five grains ; in France it is rarely given to this extent, whilst in 
this country the average dose may be stated at from five to fifteen grains. 
As already remarked, its action does not augment in a direct ratio with 
the dose. On the contrary, the author has instituted numerous experi- 
ments in public practice, and has found that, as a general rule, five 
grains are more certain in their operation than twenty. In all cases, 
when it does not act upon the bowels, another cathartic should be 
administered, as its retention may induce the constitutional effects of 
mercury. Children generally require almost as large a dose as adults, 
a child of two years of age requiring three to five grains ; — their intes- 
tinal canals not seeming to be more impressible to the action of this 
irritant than those of adults. 

The United States Pharmacopoeia has a form for PILULE HYDRAR'GYRI 
CHLO'RM MTIS, Pills of mild chloride of mercury, in which the calomel 
is made into pills of one grain each by means of gum arabic pow- 
der and syrup. Calomel pills are generally, however, made extempo- 
raneously with the same excipients or with confection of roses ; and 
they have the advantage, that they separate more readily in the stomach ; 
whilst those that have been long kept in the shops have been known 
to pass through the tract of the intestines unchanged. 

Mild chloride of mercury is employed in the formation of Hydrargyri 
Oxidum Nigrum, and it is one of the ingredients of the Pilulse Cathar- 
ticas Composite of the Pharmacopoeia of the United States. 

19. PIL'TJL^ HYDRAR'GYRI.— MERCU'RIAL PILLS. 

Mercurial pills, blue pills, are formed by rubbing mercury with con- 

fection of roses, till all the globules disappear ; then adding liquorice 

powder, and beating the whole into a mass. In the Pharmacopoeias of 

London and the United States, one grain of mercury is contained in 

three of the mass, — blue mass, as it is called from its colour. 

Even at the present day, after much attention has been paid to the 
subject, it is a matter of dispute as to what is the condition of the mer- 
cury contained in this preparation, as well as in others where it is divided 
by friction with substances not apparently adapted for exerting any 
chemical agency upon it, as in Unguentum Hydrargyri, and Hydrar- 
gyrum cum Cretd. Many distinguished cheWsts of the day are dis- 



SALINE CATHARTICS. 189 

posed to regard it as merely in a state of mechanical division. In the 
absence of chemical proofs, it would be an objection to this view, that 
metallic mercury is admitted to be wholly without action on the living 
economy. It has been found, however, that the vapour disengaged 
from mercury at atmospheric temperatures contains some oxide ; and 
it is affirmed by a distinguished pharmacological writer, Dr. Chris- 
tison, that, during the last eight years, he has examined various samples 
of Unguentum Hydrargyria and has never failed to detect a sensible 
proportion of oxide in it; and "although the same fact," he adds, 
41 has not yet been proved of the pill and powders of mercury, there is 
not yet any conclusive evidence to the contrary." Although, therefore, 
the point is unsettled, it may be esteemed probable, that a portion at 
least of the divided mercury in Pilules Hydrargyri has undergone oxi- 
dation. It was under the idea, that the metal is in the state of protox- 
ide, that Mr. Donovan proposed, that the protoxide should be introduced 
into the materia medica. This is HYDRARGYRI OX'IDUM NIGRUM of the 
Pharmacopoeia of the United States ; Hydrargyri oxidum, of that of 
London, Suboxide, J$sh, Gray, or Black oxide of mercury. It is the 
precipitate thrown down from mild chloride of mercury by means of 
potassa. It is rarely, however, used internally, and owing to the occa- 
sional presence of the peroxide is liable to operate harshly. Under 
another head, it will be seen, that it is employed externally as a mercu- 
rial revellent. 

When Pilulae Hydrargyri are given as a cathartic, the dose may be 
five grains at night, followed by a draught of senna and sulphate of 
magnesia, or sulphate of magnesia alone, on the following morning. 
Of itself, it will rarely act satisfactorily as a cathartic. The practice of 
administering it as above mentioned became common and empirical, 
greatly owing to the frequent recommendations of it by the late Mr. 
Abernethy in disorders of the digestive function ; and the author has 
seen many cases in which mischief was produced thereby. A constant 
repetition of such agents is, indeed, as elsewhere remarked, well 
adapted for inducing all the characters of bilious affections, which, in 
the generality of cases, are, in strict pathology, derangements of the 
stomach and intestines ; and it need scarcely be repeated, that too fre- 
quent a repetition of cathartics may give rise to the very evils for the 
fancied removal of which they are administered. 

SALINE CATHARTICS. 

As the saline cathartics act much alike, they may be classed together. 
They are generally given much diluted with water. When concen- 
trated, they would seem, according to Liebig, to have a physical, as 
well as a dynamic action. They extract water from the coats of the 
stomach and thence create thirst. Part of the solution becomes di- 
luted in this way, and is absorbed ; but the greater part passes into 
the intestines, dilutes the solid matters, and acts as a cathartic. Con- 
centrated saline solutions, according to M. Poiseuille, produce en- 
dosmose of serum. He found, after the use of saline cathartics, a con- 
siderable quantity of albumen in the evacuations. 



190 SPECIAL CATHARTICS. 

20. MAGNE'SLE SULPHAS.— SULPHATE OF MAGNE'SIA. 

Sulphate of magnesia is the common Epsom salts, or Bitter 'purging 
salts. It is a constituent of sea water, and of many mineral springs ; is 
found in some soils, at times efflorescing in capillary crystals ; and in 
this country is met with abundantly in many of the caverns on the west 
of the Alleghany mountains. 

Formerly, Epsom salts were prepared exclusively from the Epsom 
waters by evaporation and crystallization, and the salt is still prepared 
from the springs of Seidlitz and Seydschutz. In Great Britain it is 
made either from Dolomite or Magnesian limestone, by converting the 
carbonate of magnesia into a sulphate; or from the bittern left after the 
preparation of common salt, from which it is obtained by simple evapo- 
ration and crystallization. In Baltimore, it is extensively manufactured 
from magnesite — the siliceous hydrate of magnesia, which abounds in 
the neighbourhood of that city. It contains less lime than dolomite. 
These works mainly supply the United States. Sulphate of magnesia 
is always prepared by the manufacturing chemist, and the quantity an- 
nually consumed in the formation of magnesia, and as a therapeutical 
agent, is enormous. 

As met with in the shops, it is sufficiently pure for medicinal pur- 
poses. It is in small acicular crystals ; but by solution, and re-crystal- 
lization, tolerably large rhombic prisms, often truncated on the obtuse 
edges, and terminated by two or four converging planes, are obtained. 
The crystals are colourless, transparent, without smell, but of a bitter, 
disagreeable taste. The pure sulphate effloresces,. but, owing to an ad- 
mixture of chloride of magnesium, it occasionally deliquesces. It dis- 
solves in its own weight of water at 60° Fahr., and three-fourths of its 
weight of boiling water. It is insoluble in alcohol. 

Sulphate of magnesia possesses the characters of the whole class of 
saline cathartics, acting upon the entire tract of the intestinal canal, and 
increasing the secretion from the lining membrane, and at the same time 
the peristaltic action, so that the evacuations are numerous and watery. 
The great objection to it is its nauseous taste ; yet it often regains on 
the stomach when other cathartics would be rejected. This is especially 
the case with a mixture of the sulphate of magnesia and the carbonate as 
in the following form : — Magnes. sulphat. 5 v j ', Magnes. carbonat. 3ij ; 
Aquae menthae piperit. ^iiss. M. Dose ; one half, to be repeated if 
necessary. Alone, or associated with infusion of senna, it is one of the 
most common cathartics, both with the professional and the unprofes- 
sional. Like all the saline cathartics, (as elsewhere remarked,) it ope- 
rates best when dissolved in a large quantity of water. The ordinary 
dose is one ounce ; but in cases of constipation it is best to administer 
a small quantity— as a drachm — every morning until the sensibility of 
the mucous membrane is developed to the necessary degree, which it 
generally is sooner or later. The addition of diluted sulphuric acid, or 
of elixir of vitriol, so as to form a supersulphate of magnesia, adapts it 
as an excellent laxative and local stimulant in cases of hemorrhage from 
the stomach and intestines. In the dose of an ounce or two, it is pre- 
scribed as an adjunct to cathartic enemata. 



MAGNESIA CITRAS. 191 

Moxon's aperient effervescing Magnesia contains tartrate of mag- 
nesia in an effervescent form with tartrate of soda and potassa, and sul- 
phate of magnesia. It is used in indigestion, heartburn, &c. Mr. 
Durand, of Philadelphia, imitates it as follows: Take of Carbonate of 
magnesia, one part ; Sulphate of magnesia, Bicarbonate of soda, Tartrate 
of soda and potassa, Tartaric acid, each two parts. The ingredients are 
dried, reduced to powder, and mixed. The compound is then inclosed 
in perfectly dry bottles, and sealed over. The dose is a tea-spoonful 
in half a tumblerful of water, drunk in a state of effervescence. 

Chloride of magnesium, or Muriate of Magnesia. — Magne'sii 
chlo'ridum, Magne'siji: mu'rias, has been recommended as a saline 
cathartic by Dr. Lebert. It is said to exert no injurious effect on the 
stomach ; and to produce less inconvenience than most other cathartics. 
Its purgative action is said to be followed by improvement of the appetite. 
The mean dose for and adult is an ounce ; and half that quantity for 
one from ten to fourteen years of age. 

21. MAGNE'SIiE CITRAS.— CITRATE OF MAGNE'SIA. 

This salt is an agreeable saline cathartic, which has been introduced 
into the materia medica within the last few years. It is prepared by 
saturating a solution of citric acid either with magnesia or carbonate of 
magnesia. Dr. Pereira has found, that a scruple of the crystallized acid 
of commerce saturates about fourteen grains of either light or heavy 
carbonate of magnesia. 

Neutral citrate of magnesia, prepared either in this way, or by double 
decomposition from sulphate of magnesia and citrate of soda, is a white 
pulverulent insipid salt, soft to the touch, heavier than magnesia, and 
soluble in water by the aid of a slight excess of acid. The solution has 
an acidulous taste without anything disagreeable. It is a mild and 
agreeable aperient in the dose of two or three drachms. The dose as a 
purgative is one ounce. The most agreeable mode of administration is 
in solution in water acidulated with citric acid, and flavoured with syrup 
of lemon or orange peel, and it may be taken either in the still or efferves- 
cing state. Four drachms of crystallized citric acid, and three and a half 
drachms of common carbonate of magnesia, dissolved in a sufficient quan- 
tity of water, yield rather more than an ounce of the solid citrate ; so that 
if to these ingredients either of the syrups mentioned above be added, 
with the carbonated or mineral water of the shops in the quantity of half 
a pint, an agreeable preparation is the result, which generally operates 
kindly. 

Different formulae for its exhibition are given by MM. Roge Delabarre, 
Duclou, Garot, V. Gamier, Maury, Cadet Gassicourt, and others; but 
the effervescent solution, prepared as above, is, perhaps, the most satis- 
factory. Dr. Pereira has proposed the following : 

. Liquor magne'sije citra'tis. — Solution of citrate of Magnesia, 
Magnesian lemonade ; {Acid, citric. 3ss ; Magnes. carbonat. 9j ; Syrup, 
aurarit. f.^ij ; Aquae destillat. f.§ij.) These proportions of acid and mag- 



t . 



192 SPECIAL CATHARTICS. 

nesia are equal to about 44J grains of crystallized citrate of magnesia, 
and a slight access of acid. 

LlQUOR MAGNE'siiE CITRA'tIS EFFERVEs'c ENS. —EFFERVESCING SOLUTION 

of Citrate of Magnesia, Effervescing magnesian lemonade. (Acid, 
citric. 5ss; J9q. destillat. f.§j ; Syrup, aurant. f.3ij. M.) To be taken 
with f.^x. of Dinneford's solution of bicarbonate of magnesia in a state 
of effervescence. 

.22. SODjE SULPHAS.— SULPHATE OF SODA. 

Sulphate of soda, commonly called Glauber's salts, is contained in 
many mineral springs, and is produced artificially in several chemical 
processes. It is rarely, or never prepared by the apothecary, being 
manufactured on a very extensive scale by the wholesale chemist. It 
is made from the salt remaining after the preparation of chlorohydric or 
muriatic acid ; which is sulphate of soda, usually with the addition of 
free sulphuric acid. To neutralize this, the London College directs 
carbonate of soda ; the Edinburgh College, carbonate of lime. The 
latter is more economical. It would appear too, that in consequence of 
the enormous consumption of sulphate of soda in the manufacture of 
carbonate of soda, the sulphate is sometimes made directly by the addi- 
tion of sulphuric acid to chloride of sodium. In some of the Northern 
States, particularly in Massachusetts, a portion of Glauber's salt is pro- 
cured from sea-water in the winter season. During the prevalence of 
very cold weather, sulphate of soda, being the least soluble salt that 
can be formed of the acids and bases present, separates in the form of 
crystals. (Wood and Bache.) 

Sulphate of soda is in colourless crystals, having the same crystalline 
form as sulphate of magnesia and sulphate of zinc, which it resembles 
in general appearance. It rapidly effloresces on exposure to the air, and 
ultimately falls into a white powder. It dissolves in three parts of water 
at 60°, and in one part at 212° ; and is insoluble in alcohol. Its taste 
is cooling, but bitter and very nauseous, which is the great objection to 
it as an internal medicine. Owing to its cheapness, it is not subject to 
adulteration, and as met with in the shops is adapted for all therapeuti- 
cal purposes. 

In its medical properties, it is similar to sulphate of magnesia, which 
has now taken its place. When the author was a pupil, the sulphate of 
soda being somewhat cheaper than the sulphate of magnesia was the 
common purgative with the people ; whilst the latter, being somewhat 
less disagreeable, was used by the better classes. An ordinary * dose of 
salts'' is one ounce : this may be taken dissolved in water, to which a 
little dilute sulphuric acid, bitartrate of potassa, or lemon-juice has been • » , 
added; or in mint water, which masks, in some degree, its disagreeable 
taste. '.V 

If in an effloresced state, or dried so that its water of crystallization ' i* 
is expelled, half the quantity will be a sufficient dose. 






POTASSA TARTRAS. 193 

23. SODJE ET POTAS'SjE TARTRAS,— TARTRATE OF POTAS'SA AND SODA. 

This salt, formerly called Seignette's salt, Set de Seignette, and still 
not unfrequently termed Rochelle salt, is made by neutralizing bitar- 
trate of potassa with carbonate of soda, — the excess of acid in the bitar- 
trate being saturated by the soda of the carbonate, whilst the carbonic 
acid is disengaged. It is in colourless, transparent crystals, which are 
prisms or halves of prisms, presenting six, eight or ten sides, and the 
primitive form of which is the right rhombic prism. It effloresces 
slightly in dry air, and is wholly and readily dissolved in five parts of 
boiling water. Its taste is saline and slightly bitter. It is not liable to 
adulteration. 

Tartrate of potassa and soda is a mild refrigerant cathartic,; — less dis- 
agreeable to the taste than the neutral salts generally employed. It is a 
constituent of Seidlitz poivders — so called — which consist of a mixture 
of two drachms of this salt, and two scruples of bicarbonate of soda, put 
up in a white paper ; and of thirty-five grains of tartaric acid in a blue 
paper. These are dissolved separately in water, and taken in the state 
of effervescence. The dose is from 3ss to 3j. 

24. SODjE PHOSPHAS.— PHOSPHATE OF SODA. 

This salt, sometimes called tasteless purging salt, is prepared from 
bone earth. A formula is given in the Pharmacopoeia of the United 
States. In this, sulphuric acid is made to act upon bone ash, which con- 
sists of phosphate of lime united with some carbonate. In this manner, 
sulphate and superphosphate of lime result ; the latter of which remains 
in solution, — the former being mainly precipitated. Carbonate of soda 
is then added ; phosphate of lime is precipitated, and carbonic acid 
disengaged. The formation of crystals of phosphate of soda is pro- 
moted by a slight excess of carbonate of soda. 

Phosphate of soda is in colourless transparent crystals, which speedily 
effloresce on exposure to the air, and are in oblique rhombic prisms. It 
has a mild saline taste, resembling that of common salt ; has an alkaline 
reaction, and yields a yellow precipitate with nitrate of silver, which is 
soluble both in nitric acid and ammonia. It dissolves in four times its 
weight of cold water, and twice its weight of hot ; and is almost in- 
soluble in alcohol. 

It possesses the same virtues as the other saline cathartics, with this 
advantage, that its taste is far more agreeable. It may be given in soup 
or gruel, to which it communicates a taste like that of common salt. It 
may be administered to children more easily than any other cathartic of 
the class. By those, who have considered it desirable to restore to the 
blood the saline matter, which it may have lost in spasmodic cholera, 
the phosphate of soda has been often selected as the saline agent. 

The dose, as a cathartic, is from 5j. to §ij. 

25. POTAS'S^E TARTRAS.— TARTRATE OF POTAS'SA. , 

Tartrate of potassa, soluble tartar is made by neutralizing the excess 
. . Vol. I.— 13 



194 SPECIAL CATHARTICS. 

of acid in the bitartrate of potassa by the addition of a boiling solution 
of carbonate of potassa. The tartaric acid unites with the potassa, and 
the carbonic acid is disengaged, after which some insoluble tartrate of 
lime is separated by filtration ; and the liquor is evaporated so that the 
tartrate may crystallize on cooling. 

When properly prepared, it is in white crystals, which are somewhat 
deliquescent, or become moist in damp air ; and are entirely soluble in 
their own weight of water. Its taste is saline,- and somewhat bitter : 
most commonly, it is in a granular state, owing to the solution having 
been evaporated to dryness. 

Tartrate of potassa is a mild cathartic ; but is rarely given alone. 
It is sometimes added to other cathartics, as to infusion of senna, the 
griping effects of which it is said to correct like saline cathartics in 
general. It is occasionally administered as a refrigerant laxative in fe- 
brile affections. The dose, as a laxative, is a drachm or two ; as a pur- 
gative, 5ss. to §j. 

26. POTAS'S^E BITAR'TRAS.— BITART'RATE OF POTAS'SA. 

Bitartrate of potassa, supertartrate or acid tartrate of potassa, 
acidulous tartrate of potassa or cream of tartar, is crude tartar, argol or 
impure supertartrate of potassa purified. Tartar exists in grape juice, 
but as it is very slightly soluble in alcohol and water, it is deposited 
when alcohol is produced, and forms an incrustation on the sides of 
wine casks. This is purified on a large scale, in France, by solution 
and crystallization; and it is from that country that we receive it. The 
purest salt is obtained, according to Dr. Christison, by dissolving that 
which has been purified, gradually evaporating the solution, and remo- 
ving the crust of bitartrate, which forms on the surface, and which has 
given the name cream of tartar to the salt. 

As met with in the shops, it has either the form of white crystalline 
crusts, which are gritty under the teeth ; or, what is more common, of a 
fine white powder. It is devoid of smell, but has an acidulous and not 
disagreeable taste. It is soluble in 90 parts according to some — 60 ac- 
cording to others — of cold water; and in about 15 of boiling water ; 
and is insoluble in alcohol. It is liable to be adulterated by white mine- 
ral and other powders ; and usually contains from 2 to 5 per cent, of 
tartrate of lime, which does not, however, interfere much with it in a 
medical point of view. When pure, it is wholly soluble in boiling 
water ; and if impure, the extraneous matters remain undissolved. 
Should it be adulterated by either alum or bisulphate of potassa, the 
fraud will be detected by chloride of barium, which throws down 
white sulphate of baryta, insoluble in nitric acid. 

In small doses, bitartrate of potassa is a gentle laxative ; and, associ- 
ated with sulphur, is a common domestic remedy for preserving the 
health of children in spring and autumn. In larger doses, it acts more 
powerfully, and is often given along with jalap, senna, and other cathar- 
tics to exert a hydragogue effect. When prescribed as an aperient, it. 
may be in the dose of a drachm or two ; as a hydragogue cathartic, 
from half an ounce to an ounce. Molasses is as good a vehicle as any. 






POTASS m SULPHAS. 195 

When associated with sulphate of magnesia, its acidity masks the disa- 
greeable taste of the latter; and a solution, formed of the two, makes an 
excellent aperient in habitual constipation. (See page 148.) 

Bitartrate of potassa is employed in the preparation of antimonii et 
potasses tartras, Jerri et potassce tartras, potassce tartras, pulvis jalapce 
compositus, and sodce et potassce tartras of the Pharmacopoeia of the 
United States. 

27. POTAS'SiE SULPHAS.— SULPHATE OF POTAS'SA. 

Sulphate of potassa, — of old, sal poly chr est or salt of many virtues, 
is found in both kingdoms of nature ; but that which is used as a medi- 
cine is prepared artificially. It is made on the large scale from the salt, 
which remains after the distillation of nitric acid from nitrate of potassa. 
This has an excess of sulphuric acid, which may be neutralized, as 
directed by the Dublin College, by carbonate of potassa. The London 
College ignites the salt in a crucible, until the excess of sulphuric acid 
is entirely expelled ; whilst the Edinburgh College neutralizes it with 
carbonate of lime. Both these processes are more economical than 
that of the Dublin College. 

As we meet with it, sulphate of potassa has usually the shape of single 
or double six-sided pyramids. The crystals are of a white colour, very 
hard and permanent in the air; devoid of smell, and of a bitter saline 
taste. They require sixteen times their weight of water at 60° to dis- 
solve them, and five times their weight of boiling water ; and are inso- 
luble in alcohol. 

It is a mild cathartic, operating without any unpleasant concomitants ; 
but is rarely employed. As a laxative, it might be given in the dose 
of 20 or 30 grains; as a purge, in doses of 4 or 5 drachms. It is some- 
times, but not often, combined with rhubarb, in dyspeptic cases ; and 
in gastro-intestinal affections of children, which are accompanied with 
constipation. 

It enters into the composition of pulvis ipecacuanhas compositus or 
Dover's powder, not on account of its medical virtues, but because by 
reason of its hardness it facilitates the division of the opium in the pro- 
cess of grinding or pounding. 

Cases have been published, in which large doses of the salt — 
an ounce and upwards — given as a cathartic, have proved fatal. It 
would seem, that it is constantly employed in France as a domestic 
remedy by nurses, to diminish or stop the flow of milk in puerperal 
females ; and it is supposed, both in that country and in England, to 
have the power of inducing abortion. It is very difficult to pulverize ; 
and a portion of its irritating properties may be dependent upon mecha- 
nical excitation of the mucous surfaces with which it comes in contact. 



Potas's.e bisul'phas, Bisulph! 'ate or super sulph! ate of potas'sa, is 
officinal in the British Pharmacopoeias. The London and Edinburgh 
Colleges direct it to be made by adding sulphuric acid to a solution of 
the salt that remains after the distillation of nitric acid. It is a white 



196 SPECIAL CATHARTICS. 

salt; has a very acid taste and reaction, and is soluble in twice its 
weight of water at 60°. 

It may be given in the same cases as sulphate of magnesia with 
excess of sulphuric acid. Like sulphate of potassa it is laxative, and 
has the advantage of being more soluble ; but cannot always be sub- 
stituted for it. In cases of want of tone of the digestive organs, accom- 
panied by diminished secretion of acid, the acid acts beneficially as a 
tonic ; and in hemorrhage from the bowels, good may result from the 
local astringent influence of the acid on the vessels concerned, whilst 
the salt may carry off the blood that has been effused. It is not, how- 
ever, much prescribed at the present day, and perhaps not at all on this 
side of the Atlantic. 

28. POTAS'S^ ACE'TAS— ACETATE OF POTAS'SA. 

This salt may be formed by the direct combination of acetic acid and 
carbonate of potassa ; evaporating and crystallizing. The acid unites 
with the potassa of the carbonate; and carbonic acid is disengaged. 

As met with in the shops, it has a white, foliaceous, satiny appear- 
ance ; is soapy to the feel ; inodorous, and has a strong saline, warm, 
and rather acrid taste. It is extremely deliquescent, and therefore 
requires to be excluded carefully from the air. At 60° Fahr., accord- 
ing to Dr. Pereira, 100 parts dissolve in 102 of water. It is very soluble 
likewise in alcohol. When pure, it is perfectly neutral, and does not 
change the colour of litmus or turmeric. It is rarely adulterated, and 
never perhaps so as to interfere with its medicinal use. The Pharmaco- 
poeias of London and the United States lay down certain tests of its 
purity ; but the Edinburgh considers them unnecessary. 

Acetate of potassa is a mild cathartic ; but it has been more cele- 
brated as a diuretic, whence its old name, sal diureticus. Owing to its 
affecting both the intestines and kidneys, it has been prescribed as a 
cathartic and diuretic in dropsy. To produce the former effect, it should 
be given in the dose of 3ij to 3i\j- 

29. SO^II CHLO'RIDUM— CHLORIDE OF SO'DIUM. 

Muriate of soda, common salt, is extensively met with in the inorganic 
kingdom, and in both plants and animals. Its source, however, as an 
article of commerce, is in the water of salt springs, and in that of the 
sea. It occurs, too, in mines in various parts of the world. In this 
country, the chief saline springs are in New York, and Virginia, — the 
salt works at Kanawha, in the latter state, being estimated to have 
yielded two million bushels of salt in the year 1835. (Wood & Bache.) 

Salt, dug from the earth, is sold in the crude state under the name of 
rock salt. It is purified by solution, and crystallization. From sea- 
water it is made in the same manner, the evaporation being either 
accomplished spontaneously, or by heat. Sea water contains about 2.25 
per cent, of it. The salt, which is obtained spontaneously, is bay salt: 
it is in large grains. The ordinary salt is procured by artificial evapo- 



JALAPA. 197 

ration. It is in small white, irregular grains ; and is the form in common 
use. Basket salt is common salt dissolved and recrystallized ; and is 
so called from being often sold in baskets. This and the bay salt are 
the best qualities. 

The crystals of common salt are white cubes ; and, when pure, it un- 
dergoes no change in the air: as, however, it generally contains more 
or less chloride of magnesium, it is slightly deliquescent. ; At 60°, it 
requires about two and a half times its weight of water to dissolve it ; 
and is scarcely more soluble in boiling water than in cold. It is 
sparingly soluble in rectified spirit ; and scarcely at all so in absolute 
alcohol. 

Chloride of sodium is rarely given as a cathartic, although in large 
doses it acts not only as such, but as an emetic. It probably aids the 
action of other cathartic substances contained in mineral waters. It is 
a very common addition to cathartic enemata. As a cathartic, it ope- 
rates in the dose of 5ss to §ij. To clysters it is generally added in the 
quantity of a table-spoonful or two. 

According to Sir George Lefevre, in the form of brine in which cu- 
cumbers are preserved, it is a popular aperient in Russia. A small 
watery, seedy cucumber is preserved in salt and water, to which a very 
small proportion of vinegar, and some leaves of the black currant tree, 
are added. Thousands of barrels are so prepared annually ; and serve 
as salad for rich and poor, during winter. The liquor, impregnated 
with the rind of the cucumber, and the leaves of the black currant tree, 
is drunk in doses of a tumblerful, and seldom fails to produce the de- 
sired effect. 

Chloride of sodium is used in the preparation of Hydrargyri 
Chloridum mite of the Pharmacopoeia of the United States. 

30. MANGANE'SII SULPHAS.— SULPHATE OF MAN'GANESE. 

This beautiful rose-coloured, and very soluble salt, which is isomor- 
phous with sulphate of magnesia, is prepared on a large scale for the 
use of the dyer. It has been recommended by Mr. A. Ure as a chola- 
gogue cathartic. If a drachm, he says, be dissolved in about half a 
pint of water, and swallowed before breakfast, it will generally occasion, 
after the lapse of an hour or so, one or more liquid stools. Infusion of 
senna forms a good adjunct in special cases. More recently, Dr. Gool- 
den has confirmed the observations of Mr. Ure. In one case, the 
immediate effects of the salt were clearly marked in producing a 
copious flow of bile, which calomel had failed to do. 



III. Drastic Cathartics. 

31. JALA'PA.— JALAP. 

Jalap root, the botanical origin of which was long uncertain, is now 



198 



SPECIAL CATHARTICS. 



Fig. 30. 




Ipomcea purga. 



referred to Ipomcea jalapa or Ipomcea 
•purga ; Sex. Syst. pentandria Mono- 
gynia ; Nat. Ord. Convolvulacese ; a 
plant which grows on the mountainous 
land around Chicanquiaco, not far 
from Xalapa or Jalapa, on the eastern 
slope of the Andes, at an elevation of 
about 6000 feet. Xalapa is the only 
market for the drug, whence it is ex- 
ported through Vera Cruz. Accord- 
ing to Mr. McCulloch, the entries of 
jalap into England for home consump- 
tion amounted at an average, in 1831 
and 1832, to 47,816 pounds a year. 

The root of commerce is in round- 
ish or pyriform masses, rarely exceed- 
ing a pound in weight, and varying in 
size from that of the fist to that of a hat. 
The tubers are often, however, cut 
into pieces or sliced. They are of a 
dark brown colour ; rough and wrin- 
kled externally ; heavy, hard, and 
pulverizable with difficulty; and — 
when broken — of a grayish colour, with concentric darker circles, in 
which the matter is denser and harder. 

Jalap is liable to be worm-eaten, but it has been found that the in- 
sect eats only the amylaceous portion, so that what remains is stronger, 
weight for weight, than that which had not been touched by it. The 
powder, in which state it is generally seen in the shops, is of a pale 
grayish-brown colour, and a very disagreeable taste. 

The active properties appear to reside in a resinous substance, which 
exists in the proportion of from 9 to 13.5 per cent. ; hence water takes 
up from it chiefly amylaceous and mucilaginous extractive matter, and 
little of the cathartic principle, whilst alcohol dissolves the resin. 

A light or fusiform Jalap, called in Mexico male jalap, and said 
to be the produce of Ipomasa Orizabensis, is sometimes imported into 
this country, mixed with the true jalap, — or alone, — and sold for the 
latter. The genuine drug may be known by the characters above de- 
scribed : whenever it is light, of a whitish colour externally, of a dull 
fracture, and spongy or friable, it ought to be rejected. (Wood & 
Bache.) From July 1848 to April 1849 inclusive, Dr. Bailey, inspec- 
tor of drugs at the port of New York, rejected 3756 lbs. of jalap from 
Tampico ; 5217 lbs. from Vera Cruz ; and 3550 lbs. from Havana. 

Jalap is one of our most common and effective cathartics. It is said 
to have proved fatal by the violent inflammation it induced in the gastro- 
enteric mucous membrane ; but the author has never met with such a 
case. It augments the secretion from the lining membrane of the 
bowels, and, at the same time, greatly increases the peristaltic action ; 



COLOCYNTHIS. 199 

to a less extent, however, than gamboge. It is given in the same cases 
alone or associated with other articles, where it is desirable to exert -a 
considerable revellent and depletive agency on the intestinal canal, as in 
dropsy, encephalic affections, &c. . Whenever, indeed, a brisk cathar- 
tic is needed, jalap fulfils the indication. It is apt to excite nausea or 
tormina ; and hence a corrigent, as ginger or some other excitant, is 
generally added to it ; or another cathartic, which may modify its ope- 
ration. Jalap, associated with mild chloride of mercury, is one of the 
most common cathartics; — (Jalap pulv. gr. xv. ; Hydrarg. chlorid. mit. ; 
Pulv. Zingib. aa gr. v. — M.) The dose of powdered jalap is from 
fifteen to thirty grains. Its special affinity for the mucous membrane of 
the bowels is exhibited by the fact, that it purges when applied to a 
wound. To children,, it is sometimes given in cakes of gingerbread, the 
jalap being incorporated with the paste. • 

PULVIS JALAPS COMPOS'ITUS, COMPOUND POWDER OF JALAP— (Jalap, pulv. 
§j.; potass, bitart. pulv. 5ij.) The dose of this powder — which 
is a common hydragogue cathartic prescribed in dropsy, and used 
whenever an active cathartic is demanded — is from 9j to Jj. 

TINCTU'RA JALAM, TINCTURE OF JALAP— (Jalap, pulv. gviij ; Alcohol, 
dilut. Oij. Prepared either by maceration, or by the process of dis- 
placement.) This is not often prescribed alone. It is usually added 
to cathartic mixtures to quicken their operation. As a purgative, it 
acts in the dose of f.gij. to f.5ss. 

EXTRACTUM JALA'PJ], EXTRACT OF JALAP.— (Jalap, in pulv. crass. $j ; 
Alcohol. Oiv ; Aquas q. s. — made into an extract by the process of dis- 
placement.) The extract may be given in doses of ten grains as a 
cathartic ; but it is rarely used alone. It is an ingredient of the Pilulas 
catharticae compositas. 

Jalap-root is one of the bases, of Tinctura Sennas et Jalapas of the 
Pharmacopoeia of the United States. 
\ 

32. COLOCYN'THIS.— COL'OCYNTH. 

Colocynth of the shops is the fruit of Cucumis Colocynthis or bitter 
cucumber ; Sex. Syst. Monoecia Syngenesia ; Nat. Ord. Cucurbitacea?, 
deprived of its rind. It is a native of Japan, Coromandel, Cape of 
Good Hope, Syria, Nubia, Egypt, Turkey, and the Islands of the 
Grecian Archipelago; and is cultivated in Spain, whence it is im- 
ported, as well as from the Levant, Mogadore, &c. The quantity, on 
which duty was paid in England, in the year 1839, according to Dr. 
Pereira, was 10,417 lbs. 

The fruit, commonly called Coloquintida, bitter apple, is gathered 
in autumn, when it begins to assume a yellow colour, and is peeled 
and dried quickly either in the sun or in a stove. It is generally 
imported into this country peeled, but sometimes unpeeled, — the Tur- 
key colocynthi of commerce being usually peeled, the Mogadore un- 
peeled. — (Pereira.) 



200 



SPECIAL CATHARTICS. 



Fig. 31. 




Cucumis colocynthis. 



Colocynth of the shops is in whitish 
balls of about the size of a small 
orange. These are very light and 
spongy; the seeds, which are inert, 
constituting three-fourths of their 
weight. The pulp is the officinal 
portion. It has not much smell, but its 
taste is intensely and enduringly bitter 
and nauseous. It has been subjected 
to analysis, and found to contain a 
bitter or purgative principle— Co/o- 
cynthin or Colocynthite — which is 
obtained by digesting the watery ex- 
tract in alcohol, and evaporating the 
tincture thus formed. It is a bitter 
resinoid matter. The pulp, is not 
readily pulverizable. It yields its 
virtues to water and to alcohol. It 
would seem, however, that cold water 
takes up only 16 per cent., whilst 
boiling water takes up 45 per cent. 

Colocynth is a powerful irritant 
to the mucous membrane of the 
intestines, exciting, in large doses, fatal inflammation, and, as one of 
the results of its violence of action, occasioning, at times, abortion ; 
hence it has been used to induce criminal abortion, which—like other 
agents — it never accomplishes except through the violence it does to 
the system of the mother. Even in small doses, when given alone, its ope- 
ration is often very harsh ; and hence it is .usually combined with other 
articles of the class. It seems to act on every part of the intestinal 
canal ; and, unlike aloes, augments the secretion from the mucous 
membrane, and thus becomes hydragogue. As such, it is not unfre- 
quently prescribed in dropsy. 

The dose of powdered colocynth is from five to ten grains, which 
must be intimately mixed with powdered gum Arabic or starch ; but it 
is rarely given in powder. The form of preparation, most commonly 
prescribed, is the following: 

EXTMC'TUM COLOCYI'THMS COMPOS'ITUM, COMPOUND EXTRACT OF COL'OCYM. 

(Colocynth. ^vj ; aloes pulv. ijxij ; scammon. pulv. ^iv ; cardamom. 
pulv. ^j ; saponis ^iij ; alcohol, dilut. cong.) The aloes and scammony 
are added to modify the violent action of the colocynth ; the cardamom 
corrects the griping tendency of the cathartics ; and the soap is sup- 
posed to aid their solubility. It likewise adds to the consistency of the 
mass. 

Compound extract of colocynth or cathartic extract is an excellent 
and powerful cathartic, forming, like aloes, the basis of many extempo- 
raneous cathartic pills. It is very often associated with the mild chlo- 
ride of mercury, and forms an excellent cathartic (Ext. Colocynth. comp. 
3j ; hydrarg. chlorid. mit. 9j. — M. et divide in pil. xx. Dose, two or 
more, at bedtime.) 



GAMB0G1A. 



201 



The ordinary dose of compound extract of colocynth, as a cathartic, 
is from five to thirty grains. 

PIL'IM CATHARTICS COMPOSITE, COMPOUND CATHARTIC PELS. (Ext. 

colocynth. corny, pulv. ^ss; extract, jalap, pulv. ; hydrarg. chlorid. mit. 
aa 3^j 5 gambog. pulv. 9ij. — M.) This combination acts effectively in 
the dose of three pills. 

Forms for cathartic pills might be multiplied almost indefinitely. 



32. 




Hebradendron cambogioides. 
Calyx. 2. Stamens. 3. Anthers. 4. Top of anther. 5. Berry. 



33. GAMBCCGIA.— GAMBOGE. 

Gamboge or Camboge — although so .well known as a pigment and a 
drug — is the concrete 

juice of a tree not yet as- lg * 

certained. Two kinds of 
gamboge are described by 
writers — the Siam and the 
Ceylon — but it would 
seem, that the former only 
is known in commerce. , 

Although uncertainty 
hangs on the precise tree 
or trees that furnish gam- 
boge, it has been thought 
to be obtained from He- 
bradendron Cambogioides, 
Cambogia Gutta ; Sex. 
Syst. Moncecia Monadel- 
phia; Nat. Ord. Gutti- 
ferae, a tree of moderate 1 
size, which is a native of Ceylon ; and it is inferred, that in Siam it is 
procured from the same or a congenerous tree. 

Three varieties of Siam gamboge are met with in commerce ; 1, the 
pipe, so called in consequence of its being in cylinders, often hollow : 
this is the purest ; 2. the lump or cake, in masses of several pounds 
weight, containing, generally, fragments of wood, twigs, and air cells ; 
and 3. the coarse, which differs from the other in containing more im- 
purities. 

Pure gamboge is devoid of smell, and has not much taste ; but after 
it has remained some time in the mouth, an acrid sensation is expe- 
rienced in the fauces. The colour of its fragments is orange yellow, 
but when the surface is rubbed with water, it becomes a bright yellow : 
to produce this colour, it is extensively employed as a pigment. It is 
brittle, and has a smooth glassy conchoidal fracture. 

From July 1848 to April 1849 inclusive, Dr. Bailey, inspector of drugs 
at the port of New York, rejected 1,414 lbs. of gamboge from London. 

Gamboge has been carefully analyzed by Dr. Christison, who found 
the composition of the pipe variety, according to two analyses of dif- 
ferent samples, to be as follows: — resin, 74.2,— 71.6 ; arabin or solu- 
ble gum, 21.8, — 24.0; moisture 4.8 in both instances: total— 100.8, 
— 100.4. It contained no trace of volatile oil. 



202 SPECIAL CATHARTICS. 

Its effect on the economy is like that of elaterium, than which, how- 
ever, it is much less active ; and, like it, it is used whenever a hydra- 
gogue cathartic is needed, as in dropsies, encephalic diseases, &c. It 
is rarely given alone, but is usually associated with other cathartics, 
which mutually temper each other's action. Owing to its tendency to 
induce nausea and vomiting, it should be prescribed in small doses, — 
from one to three or four grains, in the form of.pill, repeated every four 
or five hours. It is one of the ingredients of the Pilulce Cathartics 
Composite of the Pharmacopoeia of the United States; In large doses, 
it is an acrid poison, inducing violent inflammation of the lining mem- 
brane of the stomach and bowels; and the deaths, which have followed 
the use of a celebrated nostrum, Morrison's Pills, have been ascribed 
to it. It has been detected in them. 

34. SCAMMCNIUM.— SCAM'MONY. 

Scammony is the concrete juice of the root of Convolvulus Scammo- 
nia or Scammonea; Sex. Syst. Pentandria Monogynia; Nat. Ord. 
Convolvulacese ; a native of Greece and the Levant. It is obtained by 
cutting the root across near its crown, and sticking shells into it to catch 
the juice that exudes. The root is very large, generally three or four 
inches in diameter, and as many feet long ; but a single root yields only 
a few drachms of scammony. The juice is milky as it exudes, and 
soon concretes under exposure to air, and evaporation. 

It is usually exported from Smyrna ; occasionally, it goes by way of 
Trieste, and, still more rarely, is shipped from Alexandria. The finest 
kind is called Virgin or Lachryma Scammony ; other varieties are 
termed seconds and thirds. Formerly, it would seem, the term Aleppo 
Scammony was applied to the finer, and that of Smyrna Scammony to 
the inferior kinds ; but no such distinction, it is said, is now known in 
British commerce. In 1839, the quantity of scammony on which duty 
was paid in England amounted, according to Dr. Pereira, to 8551 lbs. 

Scammony is said to be so generally adulterated, that it is not easy to 
fix the characters of the genuine article. It is affirmed, indeed, that 
there is no article of the Materia Medica, which is sophisticated so often, 
or which it is so difficult to find pure, even in mere specimens for scien- 
tific examination. Dr. Christison remarks, that spurious scammonies 
are so very common, the pure drug so rare, and the characters of the 
two qualities so very different, that he has known well informed retail- 
druggists who could not tell what the pure article was. 

The following have been laid down as the characters of good scam- 
mony by an accurate and practised observer, Dr. Pereira. It readily 
fractures between the fingers, or by the pressure of the nail ; its spe- 
cific gravity is about 1.2; its fracture dark, glistening, and resinous; 
the fractured surface should not effervesce on the addition of chlorohy- 
dric acid, which it would do if chalk were present ; the decoction of 
the powder, filtered and cooled, is not rendered blue by tincture of 
iodine, which it would be if starch were there. One hundred grains, 
incinerated with nitrate of ammonia, yield about three grains of ashes ; 
and sulphuric ether separates at least 78 per cent, of resin (principally,) 



, SCAMMONIUM. 203 

dried at 280° F. Such, too, are essentially the tests of purity laid down 
in the last Edinburgh Pharmacopoeia. The following tabular view of 
various spurious samples of scammony has been given by Dr. Chris- 
tison. 







Calcareous. 




Amylaceous. 


Calc. Am. 


Resin, 




64.6 56.6 


43.3 


37.0 62.0 


42.4 


Gum, 




6.8 5.0 


8.2 


9.0 7.2 


7.8 


Chalk, 




17.6 25.0 


31.6 




18.6 


Fecula, 




1.4 


4.0 


20.0 10.4 


13.2 


Lignin 


and Sand, 


5.2 7.1 


7.8 


22.2 13.4 


9.4 


Water, 




6.4 5.2 


6.4 


12.0 7.5 


10.4 



Total, 100.6 100.3 101.3 100.2 100.5 101.8 

Concrete pieces, obtained from various species of convolvulus, and 
from certain species of the Apocynacese, are described by waiters, — as 
the Montpelier Scammony, from Cynanchum Monspeliacum ; the 
Bourbon Scammony, from Periploca Mauritiana ; and the Germany 
Scammony, from Convolvulus Sepium ; but they do not appear to be 
known in the British or American markets. In the 20th volume of the 
American Journal of Pharmacy, Dr. Carson, of Philadelphia, has well 
described the varieties of scammony imported into this country. 
Amongst others he mentions gummy and black gummy scammony, in 
which the chief adulteration appears to be trangacanth or some similar 
substance, associated in the dark variety with bone black. They are in 
circular cakes, hard, compact, pulverizable with difficulty, and viscid 
when moistened. 

Pure scammony is a gum-resin, containing, however, but a small pro- 
portion of gum. According to Dr. Christisort, the analysis of two dis- 
tinct specimens gave 81.8 and 83.0 per cent, of resin ; 6.0 and 8.0 of 
gum ; 1.0 and 0.0 of starch; 3.5 and 3.2 of fibre and sand; and 7.7 
and 7.2 of water. When pure, it is almost wholly soluble in boiling 
dilute alcohol ; sulphuric ether takes up at least 77 per cent., and even 
82 or 83 per cent, if the specimen be tolerably dry. The resin is the 
cathartic principle, and is separated in the form oiResina seu Extr actum 
Scammonii of the Edinburgh Pharmacopoeia. 

Scammony is a drastic cathartic, and applicable to all cases in which 
medicines of the class are needed. It is so liable to adulteration, how- 
ever, and so uncertain, withal, in its operation, sometimes acting with 
great harshness, that it is not much used in this country, and when it is 
so, it is generally in combination with other cathartics, whose action it 
augments, whilst its own is mitigated. It is expensive, costing in Eng- 
land thirty-two shillings, or about seven dollars per pound, wholesale. 
The ordinary dose is from five to twenty grains. It is occasionally pre- 
scribed to children in combination with mild chloride of mercury, and 
an aromatic excitant to obviate its griping tendency. (Scammon. pulv. 
gr. iv ; Hydrarg'. chlorid. mit. gr. ij ; Zingib. pulv. gr. iij. M.) It may 
be made into an emulsion with milk, which diminishes its excitant and 
irritating qualities. 



204 



SPECIAL CATHARTICS. 



Scammpny enters into the composition of Extraction t 'Colocynthidis 
composition and Pilules, cathartics composite of the Pharmacopoeia of 
the United States. 



35. OTEUM TIG'LII.— CROTON OIL. 

Fig. 33. Croton oil is the expressed 

oil of the seeds of Croton Tig- 
lium or Purging Croton : Sex. 
Syst. Moncecia Monadelphia: 
Nat. Ord. Euphorbiaceae, a na- 
tive of the continent of India, 
and of the Islands forming the 
Indian Archipelago and Cey- 
lon. The seeds, formerly 
called Crana tigVii, G. tilii, 
G. Molucca, &c, are in size 
and shape similar to those 
of the castor oil plant. The 
shell is covered with a yellow- 
ish epidermis, beneath which 
the surface is dark brown or 
blackish. The kernel is of a 
yellowish brown colour, and 
forms about 64 per cent, of the 
seed. The seeds are imported 
with the view of obtaining the 
oil from them, of which they 
yield about 50 per cent, under 
strong pressure. They have 
been repeatedly subjected to 
analysis, but no important phar- 
maceutical information has ac- 
crued from it. 

The oil is obtained from the 
seeds in the same manner as 
Oleum Ricini from the seeds of 
Ricinus Communis. It would 
seem, likewise, to be obtained from the seeds of Croton Pavana, a 
native of Ava; and Dr. Burrough, who was for some time in India, in- 
formed Dr. Wood, that much of the oil, prepared there for exportation, 
is derived from the seeds of a plant entirely different from croton 
tiglium. A parcel of these seeds was planted by Dr. R. E. Griffith, who 
succeeded in raising a plant, which proved to be Jatropha Curcas, the 
seeds of which are known by the name of Barbadoes Nuts. This oil 
is weaker than the real croton oil, but is said by Dr. Burrough to be an 
efficient cathartic in the dose of three or four drops. 

Croton oil is a thickish fluid, of a honey-yellow colour, disagreeable 
smell, and very acrid taste, exciting inflammation of the tongue and 
and fauces, It has a very acrid matter associated with it, possessing 




Croton tiglium. 



OLEUM TIGLII. 205 

acid qualities — crotonic acid — which is identical with the j atrophic. 
In ether and turpentine it is wholly soluble ; in alcohol partially so. It 
is occasionally adulterated with castor oil, which may be detected by 
treating it with absolute alcohol, which dissolves the castor oil, and thus, 
lessens the volume of the oil, whilst no perceptible effect is produced 
on pure croton oil. Of the oil imported into New York, from July, 1848, 
to April, 1849, inclusive, Dr. Bailey, inspector of drugs at that port, 
rejected 1104 ounces from London. 

Croton Seeds, like the seeds of castor oil plant, are highly acrid and 
cathartic. In India they are prepared for medical use by being slightly 
torrefied, by which the shell is more readily separable, and the activity 
of the acrid property thought to be diminished. Even then the kernel 
acts powerfully as 'a cathartic in the dose of one or two grains. \ 

Croton Oil is a drastic cathartic, very valuable in one respect — that it 
can be given in small doses. In many cases of great torpor gf the in- 
testines, its action has proved very certain. Even a drop commonly^ 
produces eight or ten fluid evacuations ; but, at times, it has been ne- 
cessary to give as many as four or five drops in -.the course of ten or 
twelve hours. Like most of the drastic cathartics it occasions tormina; 
but these are less distressing than the burning sensation which it com- 
monly causes in the fauces. Not unfrequenly, also, it induces nausea 
and vomiting. It is one^of the most speedy cathartics in its operation ; 
and, being active in a small dose, is adapted for cases in which deglu- 
tition is effected with difficulty, or is impracticable, — as in apoplexy, pa- 
ralysis, &c, in which cases it may be dropped on the tongue. * It may 
likewise be employed when a revellent action on the bowels is needed, 
or in obstinate constipation where other remedies have failed. 

The ordinary dose is stated to be one or two drops ; but it will gen- 
erally operate in smaller quantity than this, even in one-fourth or one- 
half a drop, repeated every hour or two. It is usually given in the 
form of pill. (Olei tiglii gtt. iv ; Micce panis q. s. ut. ft. pil. viij: Dose, 
one, two, or more.) It has also been given in the form of emulsion, 
the objection to which is the acrid sensation it induces in the throat. 
Hufeland recommended it as a substitute for castor oil, advising that a 
drop of it should be added to an ounce of oil of poppies, and that the 
mixture should be called Oleum Ricini officinale. 

A soap of Croton oil composed of two parts of the oil to one part of 
liquor potassce, has been recommended, of which two or three grains 
prove cathartic. A tincture of the seeds has likewise been proposed, — 
formed of two ounces of the seeds from which the rinds have been re- 
moved, and one ounce of alcohol. This acts' as a cathartic in a dose of 
20 drops. 

Croton oil — as will be seen under another head-r-is a valuable counter- 
irritant ; and it is affirmed, that a few drops applied externally by w r ay 
of friction around the umbilicus, have exerted a cathartic effect. In 
obstinate cases, or where the stomach will not readily receive this or 
other purgatives, it may be tried in this manner. In another work, 
(New Remedies, 5th edit. p. 485, Philad. 1846,) the author has given 
various forms for administering croton oil, many of which, however, are 
employed by individuals rather than by the mass of the profession. 



206 



SPECIAL CATHARTICS. 



36. O'LEUM EUPHOR'BIiE LATHYR'IDIS.— OIL OF CAPER SPURGE. 

Euphorbia Lathyris, Garden Spurge, Caper Spurge, Caper plant, 
or Mole plant ; Sex. Syst. Dodecandria Trigynia ; Nat. Ord. Euphor- 
biacese, is indigenous in France. Although not a native of this country, 
it is sometimes met with in situations where it has the appearance of 
growing wild. It is easily cultivated, and in spme parts of New Jersey 
is found in abundance. The oil is obtained from the seeds in the same 
manner as castor oil from castor oil seeds. It resembles, in colour, 
Oleum Ricini, but is less dense. It has no odour when newly prepared, 
and no perceptible taste ; but speedily becomes rancid and acquires 
great acrimony. It is soluble in sulphuric ether ; insoluble in alcohol, 
and forms a soap with alkalies. 

About forty or forty-four parts of oil are obtained by expression from 
one hundred parts of the seeds. 

The oil, prepared in Europe, acts as a cathartic in the dose of from 
four to eight drops, without occasioning tormina or tenesmus, but that 
obtained from beans raised in this country is not as mild. Even when 
administered with aromatic oils, and made into a soap with alkalies, it 
has produced, in numerous instances, nausea and vomiting. It would 
seem, however, that when given in small quantities, and repeated at in- 
tervals of half an hour or an hour, it operates freely as a cathartic with- 
out inducing much nausea. It may be given in the form of pill with 
crumb of bread, or made into an emulsion with mucilage of gum Arabic, 
sugar, and water. 

37. ELATE'RIUM. 

Fig. 34. Elaterium is a substance 

deposited by the juice of the 
fruit of Momordica Elate- 
rium, Wild or Squirting Cu- 
cumber ; Sex. Syst. Monce- 
cia Syngenesia ; Nat. Ord. 
Cucurbitacese, a native of the 
South of Europe, and com- 
mon among rubbish in the 
villages of Greece and the 
Archipelago. It is cultivated 
in Great Britain for medical 
use. 

It was found by Dr. Chit- 
terbuck, that the seat of ela- 
terium is entirely in the juice 
around the seeds obtained 
without expression. When the cucumber is sliced and placed upon a 
sieve, a colourless juice flows out, which soon becomes turbid, and in 
a few hours deposits a sediment. This is the true elaterium, which 
Dr. Clutterbuck found to purge in the dose of one-eighth of a grain. 
The quantity obtained in this way is very small, not more than six 




Momordica elaterium. 



ELATERIUM. 



207 



grains having "been got from forty cucumbers. The process recom- 
mended in the British Pharmacopoeias F^ 35# 
is to slice ripe wild cucumbers and 
strain the juice, very gently expressed, 
through a very fine hair sieve ; it is 
then set by for some hours, until the 
thicker part has subsided. The thin- 
ner supernatant part being rejected, 
the thicker is dried with a gentle heat. 
It would appear, however, that the 
process, actually followed at Apothe- 
caries' Hall, London, is the following : 
— The fruits are cut longitudinally in 
halves by women, and are then placed 
in a hempen cloth, and jmt into a 
screw-press ; apparently, a tolerable 
pressure is applied, but for a few min- 
utes only, being removed before all 
the juice has ceased to run out. When 
the fruits are taken out of the press, 
they are but very slightly crushed, so 
that the pressure cannot have been 
great. The juice — as it runs from the 
press — falls into a hair sieve, through 
which it flows into a cylindrical-lipped 
glass jar. Here it is allowed to re- 
main for about two hours, in which 
time a greenish fecula is deposited. 
The supernatant liquor is then carefully 
poured off, and the thicker liquid at 
the bottom is placed on a paper filter, supported by a cloth one, stretched 
on a wooden frame ; a bitter, yellowish-brown liquor runs through, and 
a green mass is left on the filter. The latter is then carefully dried by 
a stove, and constitutes the finest elaterium. The mother liquor which 
was poured off from the deposit, is placed in shallow brown pans, and 
there lets fall a fresh deposit, which, when separated and dried, forms a 
paler elaterium. 

Elaterium of commerce appears to consist essentially of the active 
matter to which the name elaterin has been given, with the green 
colouring matter, cellular tissue, and starch expressed from the fruit, 
and mixed with the residue obtained by drying the bitter liquor with 
which the tissues and elaterin were moistened. It is in light, thin, fri- 
able cakes or segments, which bear frequently the marks of the muslin 
or paper on which they were dried. The colour is of a pale greenish 
gray, which becomes yellowish by exposure. Its taste is acrid and bitter. 
Some inferior kinds are met with, which are much curled, gummy, and 
of a brown or olive green colour. They are supposed to be prepared 
from the juice after the finest elaterium has been separated. 

A variety is imported into England from Malta, which is in much 
larger flakes than the best English elaterium, and has frequently some 




Momordica Elaterium. 

a. Pepo expelling its seeds; b. Stalk; c. 
Transverse section of the pepo. (Pereira.) 



208 SPECIAL CATHARTICS. 

paper adherent to it on which it was dried. It is not seen, so far as the 
author knows, in this country. 

So active a substance, and one so liable to variation in strength,— 
not so much from adulteration as from errors in the time of collecting or 
mode of preparation, — has necessarily attracted to it the attention of the 
chemical analyst. Dr. Paris found 100 parts to contain 26 per cent, of 
extractive ; 28 of starch ; 5 of gluten ; 25 of woody matter ; 4 of water, 
and 1 2 of a green, resinoid and bitter matter, to •which he gave the name 
E latin ; and as he ascertained that it possessed all the properties of the 
elaterium, he considered it to be the active principle. Since then, how- 
ever, this elatin has been shown to consist of chlorophylle or green 
colouring matter, with a colourless crystallizable substance, to which 
the name Elaterin has been given. 

The following table from Dr. Pereira exhibits the different strength of 
various specimens of elaterium : 

100 parts of Elaterium. Quantity of Elaterin. 

Prepared according to the London College, (Hennell,) 44 

Best British Elaterium, (Morries,) - - 26 

Worst do., (Morries,) - - - - 15 

French Elaterium, (Morries,) - - - 5 or 6 

Elaterium, (Edinburgh Phannacopceia,) - - 14.3 to 25 

Best specimens, (Balmer,) - - - 33 

Fine sample, prepared at Apothecaries' Hall in 1839, 

and dried by steam heat, (Pereira,) - 26 

Elaterium, in an over dose, is a violent acrid poison, producing in- 
flammation of the lining membrane of the stomach and bowels. In 
smaller doses, it is a drastic cathartic, causing a copious secretion from 
the follicles and exhalents of the intestines, and being the most active 
of the hydragogue cathartics. On this account it is employed in dropsy; 
and, where there has been no important lesion of the abdominal viscera, 
its revellent and depletive influence, exerted in this manner, has suc- 
ceeded in cases of active dropsy after other remedies had failed. By 
its revellent action it is likewise well adapted for encephalic affections, 
such as apoplexy, mania, &c, in which there is usually great torpor of 
the intestines. 

On account of the uncertainty of the strength of the commercial article 
and the occasional harshness of its operation, it is not much employed ; 
and, when it is, it should be given in divided doses. Half a grain, 
united with three grains of the extract of gentian as a constituent, may 
be given every hour or two until it operates. Even in thisTquantity, it 
may excite nausea and vomiting. Not unfrequently it acts on the 
bowels in the dose of one-eighth and even of one-sixteenth of a grain, 
which may be stated as the ordinary dose of good elaterium ; yet we 
rarely meet with it of such strength. Dr. Pereira affirms, that he has 
repeatedly employed, and seen others employ it, and has always ob- 
served, that a quarter of a grain of good elaterium acted very power- 
fully, sometimes bringing away several pints of fluid ; and that half a 
grain usually occasioned vomiting as well as violent purging. 



APOCYNUM CANNABINUM. 



209 



As the active part of elaterium, elaterin, is soluble in rectified spirit, 
it has been proposed to administer it in the form of tincture, made of 
one grain of elaterin, a fluidounce of alcohol, and four drops of nitric 
acid. Between thirty and forty minims seldom fail to act freely. 

The dose of the elaterium of Clutterbuck is always fixed at one- 
eighth of a grain ; that of the elaterin at one-sixteenth to one-twelfth 
of a grain. 

Some other indigenous articles that act as cathartics have been ad- 
mitted into the secondary list of the Pharmacopoeia of the United States 
— for example, — 

38. Apoc"ynum Cannab'inum, Indian Hemp : Sex. Syst. Pentan- 
dria Digynia ; Nat. Ord. Apocynacese : the root of which is officinal, 
and is powerfully emetic and cathartic. It has been used as a hydra- 
gogue cathartic in dropsy. From fifteen to thirty grains of the pow- 
dered root generally induce vomiting. It is most commonly given in de- 
coction. (Apocyn. cannab. 5iss; Jlquce Oiss ; coque ad Oj. — Dose, 
f.fj. to f.5ij.) 



Fig. 36. 



Fig. 37. 




Apocynum cannabinum. 

Vol. I.— 14 



Triosteum perfoliatum. 

a Insertion of stamens, b. Anthers, c. Section of 
ovary, d. Fruit, e. Section of do. /. Seed. g. Sec- 
tion of do. A. Embryo. 



210 



ANTHELMINTICS. 



39. Convol'vulus pandura'tus, Wild potato, Sex. Syst. Pentandria 
Monogynia; Nat. Ord. Convolvulaceae ; grows in every part of the 
United States, flowering from June to August. The root, which is the 
officinal portion, has been proposed as a substitute for jalap, in the dose 
of forty grains ; but it is rarely employed. 

40. Iris versicolor, Blue flag : Sex. Syst. Triandria Monogynia; 
Nat. Ord. Iridaceae ; found in all parts of the United States, flowering 
in June; the root of which — the officinal portion — has been used as a 
cathartic ; but it is apt to be followed by distressing nausea and pros- 
tration. The dose is from twenty to thirty grains ; but it is scarcely 
ever employed. 

41. Trios'teum, Fever-root. This is the root of Triosteum perfolia- 
tum ; Fever-root , Feverwort or Wild Ipecac. ; Sex. Syst. Pentandria 
Monogynia; Nat. Ord. Caprifoliacese; which is found in most parts of 
the United States ; flowering in June. The root is cathartic ; and in 
large doses emetic. The dose of the bark of the root — the part usually 
employed — is twenty or thirty grains ; alone or combined with other 
cathartics, as calomel. 



III. ANTHELMINTICS. 

Synox. Antithelmintica, Antiscolica, Antiverminosa, Vermifuges 1 . 

Definition of anthelmintics — Experiments on worms, out of the body — Different kinds 
of anthelmintics — True anthelmintics — Mechanical anthelmintics — Anthelmintics 
that expel worms by acting on the intestinal canal — Anthelmintics that prevent the 
formation of worms — Ectozoa — Special anthelmintics. 

This class of medicinal agents ought to embrace not only medicines, 
which prevent the generation of entozoa within the body, — but such as 
destroy or expel them, when already existing there. 

The common definition of anthelmintics is — " remedies which destroy 
or expel worms situate in any part of the alimentary canal." Drs. Murray 
and Paris restrict it to " remedies, which expel worms ;" — but this is a 
comparatively unimportant part of their operation. The great object 
is to get rid of the predisposition to their generation. The anthelmin- 
tics that destroy or expel merely remove the parasites already present 
in the alimentary tube ; but, unless the pathological condition that 
gives occasion to their reproduction is removed, the evil will constantly 
recur. 

Whilst the morbid condition was disregarded, attempts were alto- 
gether restricted to the discovery of such agents as appeared to be de- 
trimental to entozoic existence, or of such as might most effectually 
dislodge the parasites ; and the number, brought forward with such 
pretensions, has been prodigious ; yet but few are employed at the pre- 
sent day, and this partly — indeed chiefly — because the main object of 
the practitioner is properly considered to be to prevent their fresh gene- 
ration. 

Numerous experiments have been instituted on worms, that have been 

voided, — under the expectation, that some light might, in this way, be 

hrown on the agents that would probably be most detrimental to them 



ANTHELMINTICS. 211 

whilst in the body. Redi undertook several experiments on the asca- 
rides lumbricoi'des, of which the following is a partial summary: — in 
cold water, they lived from sixty to seventy hours ; in an infusion of 
coralline, more than sixty hours ; more than thirty in water rendered 
bitter by aloes ; in water saturated with salt they died speedily ; in 
brandy, still more speedily ; in syrup — and the experiment was often 
repeated — within three or four hours. In wine, one lived twenty-four, 
another forty, and a third seventy-four hours. 

It has been a question, whether the fatty oils be noxious to worms. 
They who believe, that, like insects, they are furnished with spiracula, 
have thought, that, by pouring oil upon, or anointing them, the spira- 
cula would become obstructed, and hence the animal would die. Human 
entozoa are not, however, furnished with spiracula, nor do experiments 
prove the noxious agency of oils. Coulet affirms, that he found taenia 
solium live as long in oil of almonds as in any other fluid. Arnemann 
found that human ascarides lumbricoides, as well as those of the swine, 
lived several days in oil, when kept in a warm situation. They were 
in all cases affected with restlessness and contortions; but their bodies 
became gradually languid and lax ; their movements were executed 
with difficulty, and, as it appeared, painfully; and the skin was con- 
tracted into rugae. In oil of sweet almonds, a lumbricus of the hog lived 
twenty-seven hours ; another thirty ; human lumbrici, from forty-six to 
fifty-three. In oil of bitter almonds, the lumbrici of the hog lived 
eighteen, twenty-four, and thirty-nine hours ; whilst the human died 
within thirty-four. In castor oil, those of the hog lived fifty-six ; the 
human, from forty-four to forty-eight; the distoma hepaticum, eight. 
In linseed oil, those of the swine from eighteen to tAventy ; the human 
from twenty-three to twenty-six. In oil of walnuts, those of the swine, 
twenty-two ; the human, twenty to twenty-five. In oil of the hazelnut, 
those of the hog, nineteen; the human, twenty-six. In oil of poppy, 
those of the hog, twenty; the human, seventeen, twenty-two, and 
twenty-seven. In oil of elder, those of the hog, twenty-eight; the 
human, two and three. In oil of hyoscyamus, those of the hog, eighteen 
and twenty-two ; the human, twenty-seven. In oil of beech, those of 
the hog from twenty-nine to thirty-two ; the human, forty to forty-six. 
In oil of hemp, those of the hog, sixteen and twenty-three; the human, 
twenty-seven. In oil of mustard, those of the hog, and man, thirty-six. 
In rape oil, those of the hog, twenty-one to twenty-six, — the human, 
twenty-eight ; and in oil ofbehen the human lived twenty-six hours. 

None of these experiments were as satisfactory as those instituted by 
Chabert with his empyreumatic oil, which consists of one part of the 
fetid or empyreumatic oil of hartshorn, and three of the essential oil of 
turpentine, subjected to distillation. Every kind of worm, immersed in 
it, was killed either immediately, or after the lapse of a few minutes. 
The preparations of turpentine are, indeed, among6t the most detri- 
mental to entozoic existence of the substances with which we are 
acquainted. 

Anthelmintics, according to the definition* generally given of them at 
the present day, may be divided into four classes. First, — True anthel- 
mintics. Secondly, — Mechanical anthelmintics. Thirdly, — Anthel- 



212 



ANTHELMINTICS. 



mintics, that expel worms by acting on the intestinal canal. Fourthly, 
— Anthelmintics, that prevent their formation. 

1 . True Anthelmintics. 

Of those anthelmintics, that prove destructive to entozoic life by vir- 
tue of some principle, poisonous to them, which they contain, there are 
few employed in ordinary practice ; yet the lists of the materia medica 
supply us with a host of such remedies. The preparations of turpen- 
tine, especially the oil, united, or not, with the empyreumatic animal 
oil obtained during the distillation of hartshorn, are decidedly the best; 
but the improvident employment of these and other excitant agents is 
liable to induce that debility of the digestive function and of the system, 
which is the great predisponent of worms. If the proper administra- 
tion of these remedies fails to destroy the parasites, little dependence 
can be placed upon others. 

It is singular, that M. H. Cloquet should put the aqueous decoction of 
hydrargyrum purificatum at the head of his list of anthelmintics. He 
observes, also, that he has seen ascarides lumbricoides evacuated in 
a state of torpor, after the abdomen of the patient had been rubbed with 
a mixture of ox-gall, and common soap, with oil of tansy, or oil of cha- 
momile, strongly impregnated with camphor, and garlic ; or with milk, 
holding aloes in solution, impregnated with the bitter principle of colo- 
cynth and camphor ; or with a maceratum of bruised garlic in cam- 
phorated sulphuric ether. A like effect, he says, is produced by a 
plaster composed of yellow wax, litharge, assafetida, and galbanum. 
He also recommends an application, which is neither the most elegant, 
nor the most easily attainable ; — assafetida dissolved in the gastric 
juice! " or, what is more simple, in the saliva /" Other external ap- 
plications have been recommended by Laennec, Barton, &c. : their 
action, however, may in all cases be explained in one of two ways. 
The terebinthinate, alliaceous, and other highly odorous agents may be 
absorbed into the system, and in this way come in contact with the en- 
tozoa ; but it is not probable, that they can affect them in a state of 
sufficient concentration to be detrimental. This explanation will not, 
however, apply to others. There is every reason for believing, that 
frictions, cataplasms &c, act as indirect anthelmintics only, by improv- 
ing the activity of the gastric and intestinal operations, and thus remo- 
ving the grand predisposition. 

2. Mechanical Anthelmintics. 

Of these, two only are now in general use. In the United States, 
indeed, neither of them is much employed ; but in Great Britain they 
have by no means outlived favour. They are the filings of tin or gra- 
nular tin, and mucuna or cowhage. The mode in which they act is 
described hereafter. 

3. Anthelmintics that expel worms by acting on the intestinal canal. 

The substances that operate in this manner belong to the class of 
cathartics; but they shoul4 not be of a violent character, or often 
repeated, owing to the debility they may induce in the digestive organs. 
The occasional exhibition of a brisk cathartic is often a valuable agency 



ANTHELMINTICS. 213 

not only in removing the worms, but in stimulating the gastric function 
to a more healthy action, and thus removing the predisposition. By 
exciting, too, the intestines to throw off the retained faeces, and secre- 
tions, — in which the worms are often enveloped, and find a nidus 
favourable for their generation, — they enable those anthelmintics, which 
may be prescribed, to come more immediately into contact with the 
parasites, and should, consequently, be made to precede the use of 
those remedies. Nor is it alone prior to the administration of anthel- 
mintics that cathartics are useful. When the former have been pre- 
scribed for a few days, and there is reason to hope that they have occa- 
sioned the death of the worms, a brisk cathartic may be advantageously 
given for the purpose of removing any accumulation of dead animal 
matter that may have taken place, and thus of diminishing the tendency 
to a fresh generation. The cathartics that have been chiefly used for 
this purpose, are oleum ricini, oleum tiglii, gamboge, scammony, jalap, 
aloes, and calomel, — singly or combined. 

4. Anthelmintics that prevent the formation of worms. 

This class is, after all, the most important. The great predisposition 
to invermination consists in want of tone generally, and of the gastro- 
enteric organs in particular. Accordingly, agents that are found to aid 
chylosis, prove most valuable. Charcoal has long had a character for 
being anthelmintic, and it is well known, that it has been, and is, con- 
stantly mixed with the food employed for fattening fowls for the markets 
of large towns. The charcoal contains no soluble matter ; but by grating 
over the mucous membrane of the stomach and intestines, it stimulates 
the organs concerned in digestion to greater activity, and enables a 
larger quantity of chyle to be separated from the food taken than could 
be accomplished without its agency. 

Such is the fact, with regard to salt— the condiment of condiments, con- 
dimentum condimentorum, as it has been, not inappropriately, termed. 
Where children are not allowed a proper quantity with their meals, they 
have been observed to be extremely liable to the generation of these para- 
sites ; and therefore a due allowance of salt is to be permitted, and recom- 
mended. The agriculturist administers it liberally for the prevention of in- 
vermination in his cattle ; and it is occasionally given to both animals 
and man as a true anthelmintic. Fortunately, it is much liked by children, 
who have apparently a natural. taste for it, as is the case with individuals 
of the animal kingdom, — the buffalo of our own country daily frequent- 
ing the salt licks of the west ; and all our domestic cattle lick it with 
the greatest delight. 

In the twenty-ninth volume of the London Medical and Physical 
Journal, Mr. Marshall has published the case of a lady who had a 
natural antipathy to salt ; and who was dreadfully infested with worms 
during the whole of her life. In Ireland, according to Dr. Paris, where, 
from the bad quality of the food, the lower classes are very subject to 
worms, a draught of salt and water is a popular and efficacious anthel- 
mintic ; and Lord Somerville, in an address to the English Board of 
Agriculture, refers to the effects of a punishment which formerly existed 
in Holland. "The ancient laws of the country," says his lordship, 



214 



SPECIAL ANTHELMINTICS. 



" ordained men to be kept on bread alone, unmixed with salt, as the 
severest punishment that could be inflicted upon them in their moist 
climate. The effect was horrible ; these wretched criminals are said 
to have been devoured by worms engendered in their own stomachs." 
Where the practitioner is desirous to destroy worms, the management 
may have to be somewhat modified by the particular variety ; but, the 
symptoms, that distinguish these from each other, are by no means un- 
equivocal. This is, however, of the less consequence, as all entozoa 
are induced by the same causes, and more or less affected by the same 
vermifuges. As the ascarides or oxyures vermiculares occupy the lower 
part of the bowels, and occasion a troublesome itching within the rec- 
tum, their presence maybe suspected; and medicines can be introduced 
to act upon them immediately, by the way of injection, — aided, or not, 
by anthelmintics administered by the mouth. In all cases, perhaps, it 
would be better that they should thus be placed between two fires, as it 
w r ere ; as they have been found even in the upper part of the alimentary 
tube, whence they have been ejected by vomiting ; and it is not by any 
means improbable, that the annoyance occasioned by a clyster might 
induce them to migrate, for the purpose of seeking quiet in the higher 
portions of the intestines, or at least of getting rid of the irritation to 
which they may have been exposed in the lower portion. In all cases, 
it will be necessary to investigate the condition of the system, that 
favours the unusual generation of worms, and to treat it 'accordingly ; 
but the consideration of this subject belongs more particularly to Special 
Therapeutics. 



SPECIAL ANTHELMINTICS. 
1. True Anthelmintics. 

1. O'LEUM TEREBIN'THIN^.— OIL OF TUR'PENTINE. 

Oil of turpentine — whose general properties are described elsewhere 
—singly, or combined with other agents, is the most powerful of the 
direct anthelmintics, destroying worms rapidly which may be immersed 
in it out of the body. It is likewise a cathartic, so that it is rarely ne- 
cessary to administer any other cathartic afterwards, as is the case with 
many anthelmintics. Should it not act on the bowels, it may be advisa- 
ble either to associate castor oil with it, or to follow it up in the course 
of a few hours by a dose of this oil, inasmuch as when it does not pass 
off, it may, according to Dr. Copland, by being absorbed, give rise to 
encephalic mischief, and occasionally to nephritic symptoms. It is ap- 
plicable to every variety of intestinal worm, and has proved very 
efficacious in cases of taenia. 

It may be given in the dose of f.5ij to f.Iss and more, in molasses ; 
or made into an emulsion with the yolk of egg or mucilage. (01. tere- 
binth, fjss ; vitell. ovi, seu mucilag. acac. Egvj ; Aqurn menthcepiperit. 
f.Sss— M.) Dr. Pereira states, that he has frequently administered fjiss, 
and sometimes f.§ij; and in no instance has he seen any ill effects 
from it. 



CHENOPODIUM." 215 

In cases of the oxyures or ascarides vermiculares, oil of turpentine 
may be made to come in contact with them in the form of enema. 

| 2, O'LEUM ANIMA'LE.— ANIMAL OIL. 

Animal, oil, DippePs oil, Oleum animale Dippelii, is obtained by 
subjecting animal substances, as bone, to destructive distillation. The 
commercial article is derived from the manufacture of bone black, and 
is identical with Oleum cornu cervi or Oil of hartshorn of the older 
Pharmacopoeias. It is thick, brown, viscid, and has a most disgusting 
odour. 

This oil has been highly extolled as an anthelmintic, by the Germans 
more especially; and it is unquestionably very effective even in cases 
of taenia ; but it is so inexpressibly nauseous, that but few stomachs can 
retain it. Its virtues have been ascribed to the creasote which it con- 
tains ; and they are, doubtless, dependent in part upon that constituent. 
The dose is "Iv. to ftlxx. in molasses, given for three mornings in suc- 
cession, and followed by a cathartic. 

The Empyreumatic Oil of Chabert, Oleum contra T^niam 
Chaberti, made — as before remarked — by adding one part of animal 
oil to three parts of oil of turpentine, leaving them to combine for four 
days, and then distilling three parts, has been greatly extolled. It, also, 
is very nauseous. It combines the anthelmintic virtues of its constitu- 
ents, and may be given in the dose of a tea-spoonful three times a day. 
It is a very effective vermifuge. 

3. CHENOPO'DIUM.— WORMSEED. 

Wormseed of the United States is the fruit of Chenopodium Jlnthel- 
minticum, Jerusalem Oak : Sex. Syst. Pentandria Digynia : Nat. Ord. 
Chenopodiaceae, — the ,c wormseed" of Europe being the fruit of Arte- 
misia Santonica, (Dublin College,) or of a variety of A. Maritima. Dr. 
Pereira affirms, that the substance sold in Great Britain under the name 
of " wormseed," does not consist of seeds, but of broken peduncles, 
mixed with the calyx and flower-buds. 

Chenopodium anthelminticum is an indigenous plant, which grows in 
almost every part of the United States, but especially in the south, — 
being found j in the vicinity of rubbish, along fences ; flowering from July 
to September; and the seeds ripening in autumn. These are small ; 
roundish ; light ; of a very bitter peculiar taste, and a disagreeable 
smell, which is possessed by the whole plant. Their properties are de- 
pendent upon a volatile oil separable by distillation with water. 

Chenopodium ambrosio'ides, an indigenous plant, is said to be used 
indiscriminately for it. 

Wormseed is one of the most popular anthelmintics in use in the 
United States ; and the common mode of prescribing it, to a child three 
or four years old, is to mix one or two scruples of the powder with mo- 
lasses ; administering this for three nights in succession, and prescribing 
a cathartic on the following morning. 

O'LEUI CHENOPO'MI, Oil of wormseed, Wormseed oil, is officinal in the 
Pharmacopoeia of the United States. It is of a bright yellow colour 



216 



SPECIAL ANTHELMINTICS. 



when freshly distilled, but becomes darker by age. It is administered 
in the same manner as the powder, in the dose of four to eight drops. 
It may be mixed with sugar or molasses.] 

Fig. 39. 



Fig. 33 




Chenopedium Anthelmintic um. 



Sprigelia Marilandica. 



4. SPIGE'LIA.— PINKROOT. 

Spigelia is the root of Spigelia Marilandica, Indian Pink, Carolina 
Pink, Perennial Wormgrass. Sex. Syst. Pentandria Monogynia ; Nat. 
Ord. Gentianacese ; — Spigeliaceae (Martius), an indigenous plant'of the 
States south of the Potomac, which grows in rich soils on the edges of 
woods, and flowers from May to July. It is collected in quantities by 
the Creeks and Cherokees, by whom it is packed in casks, or more fre- 
quently, in large bales, weighing from 300 to 350 lbs. ; — that in the 
casks being preferred as less likely to be damp and mouldy. (Wood & 
Bache.) 



FILIX MAS. 217 

The dried root, as met with in the shops, consists of numerous, slen- 
der, branching,* crooked and wrinkled fibres, issuing from a short 
rhizoma. These fibres are from three to six inches long. Its odour is 
faint ; taste sweetish and slightly bitter. Its activity has been assigned 
by Feneulle to a brown bitter extractive, similar to that of the cathartic 
Leguminosae, which, when taken internally, causes vertigo and a kind 
of intoxication. The virtues of spigelia are imparted to boiling 
water. 

The roots are sometimes mixed with those of a small creeping plant, 
which twines round the stem. These are much smaller and lighter 
coloured, and should be separated before the spigelia is dried. 

Pinkroot is much used in the United States as an anthelmintic ; and 
although cases are related in which it is said to have proved acro-nar- 
cotic, and even to have caused death, it is very extensively prescribed, 
and with entire impunity. Still, it is well to bear in mind, that such cases 
have been recorded, as well as the statement, that the acro-narcotic 
effects are less apt to occur when the medicine acts on the bowels, or 
is combined with cathartics. Dr. Wood affirms, that in the United 
States, it stands at the head of the anthelmintics. It certainly is highly 
esteemed by many; but others have equal confidence in the chenopodium, 
and much more in the oil of turpentine and its combinations. It is 
scarcely used in Great Britain, although it is officinal in the Pharmaco- 
poeias of London, Edinburgh and Dublin. 

The dose of the powdered root, for a child a few years old, is from ten 
to twenty grains, and for an adult from one to two drachms. This may 
be given every night, or every night and morning, for three successive 
days, and then be followed by a brisk cathartic. Or it may be associ- 
ated with calomel, jalap, or any of the cathartic powders. 

• 

INFU'SUM SPIGE'LIJ, INFUSION OP PINK-ROOT. (Spigel. gss; Aqua bul- 
lient. Oj.) The dose of this infusion, for a child a few years old, is f.5ss. 
to f.^i ; for an adult, f.§iv. to f.^viii., given in the same manner as 
directed for the powdered root ; or an equal quantity of senna may be 
added to the infusion. A preparation is generally kept in the shops, 
which is said to be much prescribed by physicians under the name of 
worm-tea, and which consists of pink-root, senna, manna and savine, 
mixed together in various proportions to suit the views of the prescriber. 
(Wood & Bache.) The author has never used it nor seen it used. 

5. FILIX MAS.— MALE FERN. 

Filix Mas, of the secondary list of the Pharmacopoeia of the United 
States, is the rhizoma of Aspidium Filix Mas or Nephrodium Filix Mas ; 
Sex. Syst. Cryptogamia Filices; Nat. Ord. Filices ; a plant which is 
indigenous in this country in shady pine forests, from New Jersey to 
Virginia, as well as in those of Europe, Asia and Africa. The rhizoma 
should be collected in the months of July, August, or "September. The 
sound parts are to be carefully dried and reduced to powder. When 
dried, its. odour is weak; taste sweet, and mucilaginous, slightly bitter 
and austere. It is generally brought to this country from Europe. 

As met with in the shops, it consists of fragments of the dried thick- 



218 



SPECIAL ANTHELMINTICS. 
Fig. 40. 




Nephrodium Filix mas. 

A. Pinnule with nine sori. (a.) 

B. Magnified portion of pinnule with sporangia. 

a. Stomata. 6, 6, Sporangia partially covered by c, the indusium. 

C. Magnified sporangum. 

a. Stalk, b. Ring. c. Membranous sac. 

D. Ruptured Sporangium with the sporule escaping. — (Pereira.) 

ened bases of the footstalks, to which small portions of the rhizoma are 
found adhering, and of the root fibres. It is recommended, that the 
stock of the apothecary should be renewed annually, as in two years the 
best article becomes useless. 

Filix mas has been analyzed by various chemists, and it is probable, 
that the anthelmintic virtues reside in volatile oil, which exists in it to 
the amount of about 7 per cent. It contains, likewise, tannic and gallic 
acids, which communicate to it its astringent properties. 

The root of male fern has been used only as an anthelmintic. It was 
the basis of Madame Nouffer's celebrated remedy for taenia, which was 
purchased by Louis XVI., in 1775, for 18,000 francs. 

The dose of the powder is one to three drachms, given in molasses 
for three nights in sutcession, and a brisk cathartic on the following 
morning. The plan adopted — and successfully, in many cases, — by 
Madame NoufTer, was to give two or three drachms of the powder in 
from four to six ounces of water in the morning fasting ; and, two hours 
afterwards, a purgative bolus composed of ten grains of calomel, ten of 
scammony, and six or seven of gamboge. But the most effective prepa- 
ration would seem to be that proposed by M. Peschier of Geneva, — the 
ethereal extract, called, also, Oleum Filicis, and Extractum Filicis 
^Ethereum, which contains not only the volatile oil, but also a fixed 
oil, tannic, gallic, and acetic acids, a muco-saccharine matter, green and 
red colouring matter, and a semi-resinous substance. It is made by 
digesting, in the cold, the root, cut small, for ten or twelve days, in a 
sufficient quantity of sulphuric ether ; after which the strained liquor is 
evaporated until the ether is removed. Peschier had known it successful 
in 150 casesj when he wrote : Ullersberger had used it in 60 cases, 
and a medical friend of his in 200 cases, with invariable success. It is 
affirmed to have proved more valuable against Bothriocephalus latus 
than Taenia solium ; and a part of the discrepancy of results has been 
ascribed to this cause. For example, it has not been found as effectual 
in the treatment of taenia at Paris, and the entozoon most .common 
there is Taenia solium. 

The dose of the ethereal extract is from twelve to twenty-four grains. 



GRANATI RADICIS CORTEX. 



219 



Fig. 41. 



It may be given in the form of pill, or in molasses, for two or three 
nights in succession, and then be followed by a brisk cathartic. 

The Ethereal Tincture of the Buds of Male Fern (one part of the buds 
to eight of ether) has been used with advantage as an anthelmintic ; and 
a decoction, in the proportion of an ounce of the rhizoma to a pint of 
water, has been occasionally prescribed. 

6. GRANA'TI RADI'CIS CORTEX.— BARK OF POMEGRANATE ROOT. 

Punica Granatum, Pomegranate ; Sex. Syst. Icosandria Monogynia; 
Nat. Ort>. Myrtaceae — Grana- 
teae (Don,) — appears to be a 
native of northern Africa, 
whence it was transported to 
Italy at the time of the Cartha- 
ginian wars. It is also indi- 
genous in Bengal, China, and 
Persia. 

The bark of the root — which 
is the part used as an anthel- 
mintic — is usually in small frag- 
ments, in quills or portions of 
quills, of a yellowish, or ash- 
grey colour externally ; and 
yellow within. It is brittle and 
not stringy, and has a faint pe- 
culiar smell, and an astringent 
taste. It has often been sub- 
jected to analysis ; and has 
been found by M. Latour de 
Trie, to contain, — 1, a matter which was considered to be peculiar, and to 
which the name Granadin or Grenadin was given, but which has been 
shown to be mannite. 2. Tannic acid, to which — as well as to a small 
portion of gallic acid — its astringency is owing ; and 3. Resin. Ana- 
lysis sheds no light on its anthelmintic properties. It yields its virtues 
freely to water. • 

Pomegranate root bark is rarely employed at the present day except 
as an anthelmintic, and not often with that view. It is said, when given 
in full doses, to induce nausea, vomiting and purging, and occasionally 
giddiness and faintness. This would seem to show that it possesses 
acro-narcotic properties, on which its anthelmintic virtues may be de- 
pendent. 

The testimony in favour of the bark as an anthelmintic has been dis- 
cordant. It is especially in cases of taenia that it has been employed ; 
and numerous trials have been made with it in England, France, Ger- 
many, and Italy ; yet in extensive experiments at the Polyclinical Insti- 
tute of Berlin it proved of no value ; but this failure was referred to some 
imperfection in the drug. The fresh bark possesses far more virtue than 
the dried : the' latter has, indeed, been regarded as inert. It is almost 
always given in decoction, which may be prepared with two ounces of 




Punica granatum. 
1. Calyx and stamen* 2. Stamen. 



3. Fruit. 



220 



SPECIAL ANTHELMINTICS. 



the bark, boiled in a quart of water down to a pint and a half. Of this, 
the dose is £Jtj, every half hour until the whole is taken. The formula, 
cited by Dr. Paris from Dr. Ainslie's "Materia Medica of Hindoostan," 
directs it to be prepared with 3ij of the fresh bark, boiled in a pint and 
a half of water, until only three quarters of a pint remain. 

An alcoholic extract of the bark of the root is recommended by Des- 
landes. 




Melia Azedarach: 



7. AZEiyARACH.— AZEDARACH. 

The bark of the root of Melia Jlzedarach ; Sex. Syst. Decandria 
Fig. 42. Monogynia ; Nat. Ord. Meliaceae ; is in the 

secondary list of the Pharmacopoeia of the United 
States.^ The tree termed Pride of China, Pride 
of India, Bead Tree, and Poisonberry Tree, is a 
native of oriental countries ; but is cultivated as 
an ornament in various parts of the world. It 
is very common in the Southern states, but does 
not flourish farther north than Virginia. 

The berries are reputed to be poisonous, yet 
they are said to be eaten by children at the 
south without inconvenience, and are considered 
to be anthelmintic. The bark of the root— the 
officinal portion— has a bitter nauseous taste. 
Its virtues are imparted to boiling water. It is regarded by many as one 
of the most valuable anthelmintics ; and when given in large doses is 
unquestionably acro-narcotic. It is usually prescribed in decoction. 
{Azedarach. recent, giv ; Aquae Oij ; coque ad Oj> et cola. Dose, 
f.gss every two or three hours, till it exhibits its effects on the stomach 
or bowels.) 

8. FUCUS HELMINTHOCOR'TON. 

Fucus Helminthocorton, Helminthocorton,' Corsican Wormweed; 
Nat. Ord. Algae— Algaceae (Lindley), is a marine plant, which grows 
on the coast of the Mediterranean, and especially of the Island of Cor- 
sica. The whole plant is employed as an anthelmintic in Europe ; but 
it is not used in this country. The American editors of the Manual of 
Materia Medica and Pharmacy, by MM. Edwards and Vavasseur, affirm 
that it is the best vermifuge with which they are acquainted, and that 
they witnessed in Corsica the most astonishing effects from it 

The dose of the powder is from gr. x. to 3ij. mixed with molasses. 
It is also given in infusion and decoction, and it is affirmed by Dr. 
James Johnson, that when thrown into the rectum it "destroys any 
worms domiciliating there as effectually as choke-damp would destroy 
the life of a miner/' Yet its effects on the economy are scarcely appre- 
ciable ; and chemical analysis sheds no light in regard to its anthelmintic 
principle or principles. 



CREASOTE. 221 

9. SO'Dl'i CHLO'RIDUM.— CHLORIDE OF SO'DIUM. 

The value of common salt — whose general properties are described 
under Cathartics — as a condiment, in the prevention of worms, has 
already been mentioned, (p. 213). It was also remarked, that experi- 
ments have shown it to be detrimental to entozoa when out of the body. 
Hence it has been administered as a true anthelmintic. Its cathartic 
agency might entitle it to be placed also under another of the divisions 
of anthelmintics. 

When given as a true anthelmintic, it is generally in large doses — 
from 3ss to 3j 5 and in cases of oxyures or ascarides vermiculares, it 
may be thrown into the rectum in strong solution. 

10. TANACE'TUM.— TANSY. 

The herb Tanacetum vulgar e, Tansy: Sex. Syst. Syngenesia Polyga- 
mia superflua ; Nat. Ord. Compositse Corymbiferse ; is an herbaceous 
plant, indigenous in Europe, but introduced into this country, where it 
grows wild on the road-sides, and is cultivated in the gardens. It 
flowers from July to September. 

The whole herb has a strong, peculiar and disagreeable odour, and a 
nauseous, bitter, and aromatic taste. It has been subjected to analysis, 
and found to be essentially composed of volatile oil — Oleum Tanaceti — 
which has the peculiar smell of the plant, and a warm bitter taste ; and 
of a bitter matter, which is usually denominated extractive, but has 
"been regarded as partly resinous. Still, the main properties are ex- 
tracted by water ; and all, probably, by alcohol. 

Tansy is chiefly used as an anthelmintic in domestic practice. It is 
rarely prescribed by the physician, and is therefore placed in the secon- 
dary list of the Pharmacopoeia of the United States. Its anthelmintic 
virtues are probably dependent both on the bitter principle and the 
volatile oil ; the latter of which is more destructive to the parasites : 
whilst the former, like bitters in general, is adapted for giving tone to 
the digestive function, and to the whole system; yet the seeds, which 
contain the largest proportion of the bitter principle, and the smallest 
of volatile oil, are said to be most effective. It is generally given in 
infusion, Tansy Tea; prepared by infusing ^ij of the herb in Oj of 
boiling water, the dose being from f.^j to f*. §iij - 

The seeds might be given in powder, in the dose of from gr. xxx. to 
3j ; or a few drops of the oil be administered in molasses. 

11. CREASOTUM.— CRE'ASOTE. 

For its general properties, see Excitants. 

Several portions of tapeworm having been observed to be discharged 
during the administration of creasote, it has been prescribed, in such 
cases, as a true anthelmintic. From five to eight drops may be given 
to adults in an ordinary dose of oleum ricini. It has, likewise, been 
associated with oleum tiglii. 



222 



SPECIAL ANTHELMINTICS. 



II. Mechanical Anthelmintics. 



12. MUCU'NA.— COWHAGE. 



Fig. 43. 




Mucuna prurjens. 
a. Flower, b. Stamens, c. United do. 
rate do. 



d. e. Sepa- 



In the language of the Phar- 
macopoeia of the United States 
mucuna is the "bristles of the 
pods of Mucuna pruriens, Dolichos 
pruriens, Stizolobium pruriens 
Cowhage, Cowitch." Sex. Syst! 
Diadelphia Decandria ; Nat. Ord. 
Leguminosae — a climbing plant, 
indigenous in the West Indies! 
The pod or legume, as met with 
in the shops, is of a brownish 
colour, shaped like the italic/, 
containing four to six seeds, and 
covered with a pubes of stinging 
hairs, setae, which, when placed 
on the skin, pierce it, and give 
rise to intense itching, and, in 
some persons, to cutaneous in- 
flammation. The best applica- 
tion, in such cases, is oil. Rub- 
bing the part always increases the 
local phenomena. 

Mucuna has long been celebra- 
ted as a mechanical anthelmintic. 



nil i. •. x- 1 • , . "*** aa a "icciiamcai anmeiminuc. 

That its action is mechanical is proved by the circumstances, long ago 
observed, that worms, under its use, are discharged alive. When 
experiments, too, have been made on entozoa out of the body, the setae 
have been observed sticking in them, and the animals twisting about 
evidently in great torture. That an anthelmintic effect is produced 
upon them by cowhage within the human body appears to be well 
supported. The testimony in favour thereof has been satisfactory ; and 
the author himself has repeatedly seen its exhibition followed by the 
evacuation of entozoa after other anthelmintics had been given fruit- 
essly. The difficulty has been to understand how it could act upon 
the worms and not equally irritate the lining membrane of the intes- 
tines, and this difficulty has caused the efficacy of the medicine to be 
discredited It is impossible, however, to set aside the numerous facts 
that have been brought forward in its favour; and it would seem, that 
the mucus, which covers the membrane, may prevent the setae from 
penetrating it as it does the worms. 

Mucuna has been considered best adapted for the removal of Asca, 
ndes lumbricaides, the 'long round worm,' and Oxyures vermicular*, 
the 'small thread worm.' The latter are, however, so low down in the 
intestinal canal, that its influence can scarcely be as powerful on them 
It may be given in the form of electuary, the pods being dipped in 
molasses, and the setae scraped off' until the mixture has attained the 



PULVIS STANNI. 223 

consistence of thick honey. Of this, a table-spoonful is a dose for an 
adult; a tea-spoonful, for a child three or four years old. It may be 
administered for three nights in succession ; and the following morning, 
a brisk cathartic may be given. 

Mucuna is not much used in this country. The framers of the last 
edition of the Pharmacopoeia of the United States have transferred it 
from the primary to the secondary list. 

13. COR'YLUS ROSTRA'TA.— BEAKED HAZEL. 

Beaked Hazel is a shrub two or three feet high, of the Nat. Ord. 
Amentacese ; Sub. Ord. Cupuliferee ; Sex. Syst. Monoecia Polyandria, 
which grows in the mountainous regions of North America. The nut 
which it produces is of an ovate shape, surrounded by a coriaceous and 
scaly involucre or cupula, terminating in a tube an inch and a half long, 
covered with short and thick bristles, very similar to those of mucuna. 
These have been found by Dr. Heubener, of Bethlehem, Pennsylvania, 
to possess anthelmintic virtues similar to mucuna, and to equal it in 
all respects. 

It may be given, like mucuna, in syrup, molasses or other consistent 
vehicle ; and in the same doses. 

14. PULVIS STANNI.— POWDER OF TIN. 

Powder of Tin, Granulated Tin, Granular Tin, is prepared by 
melting tin in an iron vessel over the fire, and, whilst it is cooling, 
stirring if until it is reduced to a powder, after which it is passed 
through a sieve. Tin may also be reduced to powder by shaking it, 
when melted, in a wooden box, the inside of which has been rubbed 
with chalk. 

The testimonials in favour of this mechanical anthelmintic have been 
numerous. It has been strongly recommended not only in Ascarides 
lumbrico'ides, but also in Tsenia solium. It was at one time conceived, 
that its good effects might be owing to its combination with arsenic ; 
but this supposition has been negatived by the equal success that 
follows its use in a pure state. In all probability, it acts by the inces- 
sant annoyance occasioned by the friction of the particles of the tin, 
which renders the situation of the entozoa uncomfortable to them, and 
induces them to migrate ; whilst the same friction on the mucous coat 
of the intestines increases their peristaltic action, and favours the object ; 
or, if it fails to do this, it augments chylosis, and improves the general 
tone of the digestive system. The dose to children is from Jss to 3ij 
and more ; to adults §ss and more, in molasses, every night, for three 
nights. On the following morning, a brisk cathartic may be given. 



224 EXPECTORANTS. 

SECTION II. 

AGENTS THAT AFFECT PROMINENTLY THE RESPIRATORY ORGANS. 



EXPECTORANTS. 

Synon. Anacathartics. 

Definition of expectorants — Organs on which they act — Modus operandi — Are indirect 
agents only — Inhalations — Special Expectorants. 

Expectorants are usually defined to be — " Agents that promote the 
excretion of mucus and other fluids from the lungs and air passages." 

To understand whether we be possessed of any substances that exert 
a special action of this kind, it is necessary to inquire into the anatomical 
constitution of the bronchial tubes, and into the mode in which reputed 
expectorants may affect them. 

The whole of the larynx, trachea, and probably bronchial tubes, 
is lined by a mucous membrane, whose office it is to secrete mu- 
cus, and to serve the purpose of mucous membranes in general. 
From this membrane it is, that the humour of expectoration is secreted. 
Surrounding the air tubes, probably even in their minutest divisions, is 
a contractile coat, which has an important agency in the phenomena of 
expectoration. In the trachea an obvious muscular structure exists at 
its posterior third, where the cartilages are wanting. This consists of a 
thin, muscular plane, the fibres of which pass transversely between the 
interrupted extremities of the cartilaginous rings of the trachea and the 
bronchia. The use of this muscular tissue — as suggested by Dr. Phy- 
sick, and, since him, by M. Cruveilhier, Sir Charles Bell, and others — is 
to diminish the calibre of the air tubes in expectoration ; so that the air, 
having to pass through the contracted portion with greater velocity, its 
momentum, in coughing, may remove the secretions, that are adherent 
to the mucous membrane. The phenomena of asthma, as M. Laennec has 
correctly observed, occasionally exhibit a manifest temporary constric- 
tion of the minute bronchial ramifications, affording, indeed, every evi- 
dence of a spasmodic attack, — the essential cause being probably seated 
in the ramifications of the pneumogastric nerves that are distributed to 
the bronchial tubes, whilst, at other times, the phenomena indicate 
rather a paralyzed than a spasmodic condition of the muscular fibres. 

The quantity and facility with which the matter of expectoration is 
secreted must depend upon the condition of the mucous membrane. 
Occasionally the sputum is derived from the breaking down of tubercles, 
or from positive abscesses in the lungs, but these are not the most com- 
mon cases in which expectorants are employed ; — such, at least, as are 
regarded to exert a special agency on the lining membrane of the air- 
passages, when taken into the stomach, or introduced, in any manner, 
into the circulation. If the bronchial mucous membrane be inflamed, as 
in acute bronchitis, the secretion from it may be wholly arrested for a 
time, after which it may become augmented, as in cases of inflammation 



MODUS OPERANDI. 225 

of mucous membranes in general ; or, if the inflammation be to a less 
extent, and protracted, a profuse secretion may take place from it, 
attended with every symptom of general asthenia, as in some of the 
cases of winter-cough or chronic bronchitis of old people. In these 
different conditions of the mucous membrane, a different condition of 
expectorant medication is demanded. In the former, marked by every 
sign of internal inflammation, the antiphlogistic plan is imperiously re- 
quired ; whilst in the latter, depletion is by no means indicated, and, 
on the other hand, general and local excitants may be found advisable. 
These, however, are indirect expectorants, adapted for the removal of 
the condition of the system, which gives rise to the diminished or aug- 
mented secretion from the bronchial mucous membrane. 

Again, when the sputa are secreted, they often adhere to the mem- 
brane, and are expelled with difficulty ; at times, because the inflam- 
matory condition, above mentioned, does not admit of their ready 
detachment ; and, at others, owing to a want of due vigour in the system 
in general, and in the mucles concerned in expectoration in particular. 
In the former case, antiphlogistics, nauseants, &c, become indirect 
expectorants ; in the latter case, substances, which, like ammoniacum, 
myrrh, and the different balsams, are excitants ; or, again, agents that 
are capable of inducing emesis, during the succussion accompanying 
whose operation the mucus becomes detached, and its expulsion favoured. 
In these cases a nauseating emetic is most beneficial, if inflammatory irri- 
tation exists to any extent ; for, during the nausea, which precedes 
emesis, the secretion from the bronchial mucous membrane is favoured ; 
and by the act of vomiting succeeding to the increased secretion, the 
mucus is readily detached, and expectorated. In this way, nauseants 
and emetics become expectorants. 

All these, however, are indirect agencies only, and it is important 
to inquire, whether there be such remedies as direct expectorants, or, in 
other words, any that act on the bronchial mucous membrane by prefer- 
ence, after having been received into the stomach, and entered the mass 
of blood ; for, it is manifest, that this is the only mode in which any 
internal expectorant can come into immediate contact with the seat of 
the mischief. The expectorant whatever it may be, must be received 
into the circulation either by imbibition through the coats of the gastro- 
enteric blood-vessels, or through the chyliferous vessels. In either case, 
it must proceed to the heart, and pass with the blood of the bronchial 
artery to the bronchial mucous membrane ; and although — as has been 
shown — it cannot be denied, that many local excitants when received 
into the blood-vessels, effect the particular parts of the frame on which 
they act by preference, we have no sufficient reason for the belief, that 
this is the case with any of the remedies that are reputed to be expecto- 
rants. None of them appear to affect the bronchial mucous membrane 
by preference : they exert upon it an indirect agency only. An atten- 
tive examination of the properties ascribed to the different agents, 
ranked under this division, can scarcely fail, indeed, to lead the intelli- 
gent therapeutist to the deductions of Dr. Paris. " If the term expec- 
torant" — he remarks — "'be intended to express a medicinal substance, 
which has the power of promoting the expulsion of fluid from the lungs, 

Vol. I.— 15 



226 EXPECTORANTS. 

by some specific action on the parts concerned, we have no hesitation 
in at once rejecting the word, and denying the existence of such reme- 
dies ; if, however, the term be received conventionally, as comprehend- 
ing all those substances, which are capable, according to the state of 
the system in each particular case, of producing expectoration, it will 
be extremely proper to recognize, arid particularly useful to retain, such 
a class of medicinal agents." A more recent writer, Dr. Spillan, has 
remarked, that " there probably exists no class of medicines, which so 
fully establish the truth of the principle, that medicines are but relative 
agents, as the class now under consideration." 

These are the only views, that can be rationally maintained, and much 
careful discrimination becomes necessary to determine upon the precise 
kind of indirect agency that may be demanded in any particular case : 
immense mischief has, indeed, been done by the promiscuous prescrip- 
tion of reputed expectorants, under circumstances contra-indicating 
their employment. The pathology of many of the varieties of cough has 
been but little attended to until of late years. Its frequent identity with 
bronchitis was not suspected, or if suspected, disregarded. Expectorants, 
in such cases, were freely administered, — substances that is, which were 
considered to be possessed of direct powers over the parts concerned in 
the formation of the matter of expectoration ; and as almost all these 
remedies belonged to the class of excitants, it may be imagined, that 
mischief frequently followed their administration. , This every practi- 
tioner must have witnessed from the injudicious use of excitant cough 
mixtures, administered when the system has been labouring under 
general febrile indisposition, connected with, or dependent upon, the 
bronchitis, for which the expectorant was originally recommended. The 
judicious practitioner, in such cases, whilst he pays proper attention to 
the febrile and inflammatory symptoms, generally restricts himself, as far 
as may be, to the employment of demulcents. These, by passing over 
the top of the larynx, soothe the mucous membrane with which they 
come in contact, and, by contiguous sympathy, the soothing influence is 
propagated to the part of the bronchial mucous membrane labouring 
under irritation. 

Almost every division of medicinal agents may become expectorant, 
according to the precise condition of the system generally, or of the 
pulmonary organs particularly ; hence we find an expectorant effect 
equally from depletives, and from tonics and excitants ; from narcotics 
and counter-irritants ; and from nauseants and emetics. 

Although the existence of any internal expectorant acting through the 
stomach and the circulation on the lining membrane of the air passages 
may be doubted, there is a mode of exhibiting remedies, so that they 
may come into immediate contact with the bronchial mucous membrane, 
so as to modify its functions effectively, that is, by inhalation. In this 
way, soothing or relaxing vapours may be made to act upon the in- 
flamed membrane, especially after the violence of inflammatory action 
has been previously somewhat subdued by appropriate antiphlogistics. 
Under such circumstances, the vapour of hot water is employed with 
much advantage, and in cases of asthma relief is occasionally obtained 
by the addition of some volatile oil, as by inhaling the vapour from a 



INHALATION. 



227 



Fig. 44. 



Fig. 45. 




Cit ^ 

jl 

1! 
II 


~t 


=5iJi=^= 


^=^== 


='^&^^ 


^— ^^ 


slfcH 


fiHP 



Inhaling Bottles. 



hot infusion of chamomile flowers. With the same view, ether is occa- 
sionally added. In some cases of asthma, there appears to be a condi- 
tion of the pneumogastric nerves 
somewhat resembling paralysis, 
which excitants, introduced in the 
manner referred to, are as well 
adapted to remove as any other 
agents. The vapours of burning 
substances, as of tar and resin, are 
occasionally inhaled, and they may 
be employed with advantage in 
chronic bronchitis, when the in- 
flammation is of an asthenic charac- 
ter, or when the activity of the 
inflammation has passed away, and 
the copious secretion from the 
membrane is the most annoying 
symptom. The vapours of % boiling 
tar were, at one time, strongly recommended by Sir A. Crichton in 
consumption, but experience has shown that not much reliance can be 
placed upon them in that fatal malady ; and many of the cases of benefit, 
derived from such inhalation, have probably been of the kind just re- 
ferred to — chronic bronchitis. 

The practice of smoking the roots of stramonium in asthma, and other 
pulmonary affections, has long existed, and frequently essential benefit 
is derived from it. There is something inexplicably capricious in this 
singular disease. Whilst one asthmatic cannot sleep in town, another 
cannot remain in the country. A friend of the author, a most respect- 
able inhabitant of Baltimore, recently dead, was unable to sleep at his 
country house, which was not more than a mile and a half from the centre 
of the town. He tried the experiment frequently, and the result was 
always the same. The author has known others who could not exist in 
the impure atmosphere of towns. Others again, prefer a dry, whilst 
many breathe more freely in a moist, atmosphere. The same thing, of 
course, applies to medicinal agents inhaled by the lungs. Tobacco re- 
lieves some, and aggravates others ; but the smoke of stramonium agrees 
with a large majority of persons, and at times affords manifest relief. 
When suffering under a severe attack of the disease, the gentleman, 
above referred to as unable to sleep in the country, frequently made 
manifest to his medical attendant the relief he derived from its inhala- 
tion. For this purpose he employed the dried stalk. Others use the root, 
and others the leaves only. (For many similar cases, see the author's 
Practice of Medicine, 3d edit. 1, 364, Philad. 1848.) 

It is, too, in the way of inhalation, that ether, chloroform, and the 
different gases have been used therapeutically. The gases were first 
proposed by the enthusiastic Beddoes, and they are certainly capable of 
affecting the frame — some as excitants, others as sedatives ; — but diffi- 
culties, connected with their efficient administration, and uncertainty in 
the results obtained, have led to their almost total abandonment. They 
pass through the bronchial tubes, penetrate the blood-vessels, by imbi- 



228 



SPECIAL EXPECTORANTS, 



bition, and exert their appropriate agency, either on the nerves distri- 
buted to the blood-vessels, or — what is more probable — affect the great 
nervous centres by reaching them through the circulatory current ; but 
such agents cannot properly be ranked as expectorants. The adminis- 
tration and effects of these, as well as of ether and chloroform, will re- 
ceive attention under other heads. 



SPECIAL EXPECTORANTS. 



Fig. 46. 



I. Excitant Expectorants. 

1. SEN'EGA.— SEN'EKA. 

Seneka, Seneka snakeroot, Rattlesnake root, is the root of Polygala 

Senega; Sex. Syst. Diadelphia Oc- 
tandria ; £Jat. Ord. Polygaleae, an 
indigenous plant common in every part 
of the United States, but abounding 
especially in the Southern and Western 
portions, where it is collected for use. 
As met with in the shops, it is of dif- 
ferent sizes, from that of a writing 
quill, to that of the little finger, having 
a thick knotty head, which exhibits 
traces of the numerous stems. It is 
contorted, often marked by crowded 
annular eminences, with a projecting 
line running along its whole length. 
The cortical portion is corrugated, 
cracked transversely, and of a yellow- 
ish-brown or grayish-brown colour. 
The smell is strong and peculiar in 
the fresh root, but faint in the dried ; 
and the taste is at first sweetish and 
mucilaginous, leaving a peculiar acrid 
sensation in the fauces. 

The whole of the virtues are re- 
sident in the cortical portion, the 
woody matter being inert, and therefore to be rejected in reducing 
seneka to powder. These virtues are yielded to boiling water, and to 
alcohol, especially to dilute alcohol. They seem to be partly depend- 
ent upon a substance called Senegin, Polygalin and Polygalic acid, 
which has been esteemed by some to be an alkaloid ; by others an acid ; 
and which, when given to dogs, in the dose of 6 or 8 grains, has caused 
vomiting, difficult respiration, and death in three hours. 

Seneka has been regarded as one of the best of the excitant expec- 
torants ; and in the form of syrup of seneka is largely used both in hos- 
pital and private practice, especially by those who prescribe according 




Polygala senega. 



Detached flower, 
adhering. 



2. Keel with stamens 
3. A seed. 



SCILLA. 229 

to a system of routine, and are guided by names rather than by phe- 
nomena. It is clearly excitant ; and, therefore, not adapted for facilita- 
ting expectoration in affections of the chest of an inflammatory character. 
Yet, like squill, it forms part of a compound syrup — Syrupus scilla 
compositus — associated with nauseating and emetic substances, which 
certainly fill contrary indications ; and — as elsewhere remarked— it is 
probable, that most, if not all of the benefit in many cases derived from 
the preparation is due to the nauseants and emetics contained in it. 
Dr. Pereira assigns to it a sphere of action, which is inexplicable; and 
to the author — who has employed it largely — inconceivable. " In this 
country" (England) — he remarks-*-" senega is comparatively little em- 
ployed. It is an exceedingly valuable remedy in the latter stages of 
bronchial or pulmonary inflammation, when this disease occurs in aged, 
debilitated, and torpid constitutions, and when the use of depletives is 
no longer admissible. It appears to re-establish a healthy condition of 
the secreting organs, to promote the resolution of the morbid deposits, 
and to give strength to the system. I usually administer it in combina- 
tion with ammonia, which appears to me to promote its beneficial ope- 
ration. Frequency of pulse, and a febrile condition of the system are 
by no means to be regarded as impediments to the use of this medi- 
cine." 

Seneka is rarely — or never — given in powder. Should it be desired 
to administer it in this form, the dose may be from ten to twenty grains. 

DECOCTM SEN'EGJ, DECOCTION OF Wi'UL— (Senega cont. Ij ; Aqua 
Oiss. Boil to a pint.) This decoction is by no means as much used 
as the syrup, the saccharine matter of which is itself demulcent, and 
therefore adapted for relieving cough and facilitating expectoration. 
Sugar, or liquorice root, or extract of liquorice, may be added to it. 

SYRU'PUS SEN'EGJ!, SYRUP OF SEN'EKA.— (Seneg. cont. liv ; Aqua Oj ; 
Sacchar. fgj. Made into a syrup, either in the ordinary method or by 
displacement.) The dose, as an expectorant, is f.Jj to f.Siij. It is a 
common adjunct to expectorant mixtures ; and, in too many cases, for 
no other reason than because it bears the name of "expectorant," with- 
out regard to the pathological condition, or its adaptation to it. 

2. SCILLA.— SQUILL. 

Squill, the general properties of which have been detailed, (p. 130), 
is often prescribed both with excitant and sedative expectorants ; yet 
the union with the latter, in the small doses in which it is usually ex- 
hibited, cannot be philosophical, inasmuch as it is unquestionably exci- 
tant ; and, therefore, adapted for cases of pectoral disease, in which 
there is an absence of all febrile and inflammatory phenomena, and a 
demand rather for excitant expectorants in general. 

When given in powder, as an expectorant, which is rarely the case, 
it is usually in the dose of one grain, two or three times a day. As, 
however, it is a nauseant in a sufficient dose, it may be adapted, in a 
larger quantity, for affections in which sedatives are needed. In such 
cases, it must be pushed until its influence on the stomach is exhibited. 



230 SPECIAL EXPECTORANTS. 

jScetum Scillce, (p. 131) is occasionally prescribed as an expectorant, 
in the dose of f.3ss to f.5j ; but by no means so frequently as the 
Oxymel (p. 131); and the syrups — simple and compound, (p. 131); 
the former in the cjose of f.3j to f.3ij ; Syrupus Scillce in the dose of a 
fluidrachm or two ; and Syrupus Scillse Compositus or Hive Syrup, in 
the dose of twenty or thirty drops. 

Tinctura Scillas (p. 131) is rarely given alone ; but is often added to 
pectoral' mixtures. Its dose is from twenty drops to a flui-drachm. 

PIL'IM SCILL M COMPOSITE, COMPOUND PELS OF S<P%- Still, pulv. gj ; 
Zingib. pulv.; Ammoniac, pulv. aa-3\j ; Saponis jiij ; Syrup, q. s. to 
be divided into 120 pills.) The dose is from 5 to 10 grains. 

3. AMMONI'ACUM— AMMCN1AC. 

The botanical history of ammoniacum has been a matter of uncer- 
tainty. Of late years, however, owing to the researches of observers in 
India, it has been referred to Dorema Ammoniacum ; Sex. Syst. Pen- 
tandria Digynia ; Nat. Ord. Umbelliferse, a native of Persia, of which 
it is the concrete juice. The whole plant contains a large quantity of 
a milky juice, which oozes out, whenever punctures are made, even at 
the ends of the leaves. It would appear, however, that these are never 
made artificially, but that innumerable beetles pierce the plant in all 
directions. When dry, the ammoniac is picked off, and collected. Dr. 
Pereira states, that he has, in his museum, the upper part of the ap- 
parently flowering stem,, about ten inches long, with lumps of ammo- 
niac sticking to it at the origin of every branch. 

Ammoniac, as met with in commerce, usually comes from Bombay, 
but sometimes from the Levant. It is either in the state of tears, or in 
lump. The former 1 is in more or less spheroidal tears, but often in 
larger pieces of an irregular shape. They are of a yellowish colour 
externally, and whitish within. At ordinary temperatures, they possess 
considerable hardness, but soften under the heat of the hand. Lump 
ammoniac consists of whitish tears, imbedded in a substance of a darker 
colour, and containing numerous extraneous matters, as seeds, frag- 
ments of vegetables, and dirt. The odour of both varieties is peculiar, 
and by no means agreeable ; and the taste nauseous, bitter and some- 
what acrid. 

Ammoniac is a gum-resin, which has been subjected to analysis by 
many chemists, and found to consist of about 70 per cent, of resin, and 
about 20 of gum. It contains also a volatile oil, which is separable by 
distillation with water. With this fluid, it forms a preparation, which 
is officinal— mislura ammoniaci. The alcoholic solution, which is 
transparent, becomes milky on the addition of water. 

It has been-long employed as an expectorant of the excitant class, 
and, consequently, in cases in which there was little or no inflammatory 
action. It would not seem, however, that its excitant properties are 
energetic ; and, from the author's experience, it is not entitled to the 
credit that has been assigned it in chronic bronchitis, and, catarrhal 
affections in general. Such, indeep 1 , appears to be the prevalent belief, 



I*..* 



MYROXYLON. 



231 



if we may judge by the much smaller employment of the drug now than 
formerly. 

The dose is generally stated to be from ten grains to thirty in pill. It 
is rarely given in this simple form, but in combination with other re- 
puted expectorants, as in Pilulce Scillce Composite of the Pharmaco- 
poeias of Edinburgh and the United States, or Pilulce Ipecacuanha 
Composites of the London Pharmacopoeia, (Pulv. Ipecac, comp. 5iij ; 
Scillce recente exsiccat., Ammoniac, aa 3J ; Mucilag. acacice q. s. ut 
fiat massa. Dose, five grains to ten.) 

MISTU'RA AMMONTACI, AMMONIAC MIXTURE .— (Ammoniac 3jj ; Aquee Oss. 
This mixture was formerly called Lac Ammoniaci, owing to its white 
appearance. The gum of the gum-resin forms a mucilage, by which 
the resinous portion is suspended. The greater part of the resinous 
matter subsides, however, on standing. When given alone in pectoral 
affections, the ordinary dose is one or two table-spoonfuls. It not 
unfrequently forms a vehicle for other agents, as Tincture of Opium, 
Syrup of Seneka, &c. 

4. MYROX'YLON.— BALSAM OF PERU. 



Fig. 47. 




, Myroxylon peruiferum. 



Balsam of Peru is the 
juice of Myroxylon or My~ 
rospermum Peruiferum : 
Sex. Syst. Decandria Mo- 
nogynia, Nat. Ord. Legu- 
minosse, which is indige- 
nous in Peru, New Grenada, 
Colombia, and Mexico. 

In regard to its history 
there is some uncertainty. 
It has been affirmed, that 
there are two modes of ob- 
taining it— one by incisions 
made into the bark of the 
tree, and the other by boil- 
ing the branches and trunk 
in water ; — the former yield- 
ing a white liquid balsam ; 
the latter a blackish-red 
liquid. The former, it is 
said, may be preserved for 
years in the fluid state ; but 
if deposited in calabashes, 
which is commonly done in 
the mountains of Tolu, it 
condenses, after a time, and 
hardens into resin ; it is 
then termed dry white bal- 
sam or balsam of Tolu; 



232 



SPECIAL EXPECTORANTS. 



whilst the extract, made by boiling the bark in water, is blackish, re- 
mains liquid, and is known by the name of black Peruvian balsam. 
There seems still, however, to be a doubt, whether the black Peruvian 
balsam of the shops is prepared by coction. 

The quantity of balsam of Peru on which duty was paid in England, 
in the year 1839, was, according to Dr. Pereira, 825 lbs. 

Balsam of Peru is transparent, of a deep reddish-brown colour, and 
of the consistence of molasses. It has a fragrant aromatic odour ; and 
a hot and bitter taste. It is soluble in alcohol, and miscible with water 
by means of mucilage. Its specific gravity is variously stated, from 
1.14 to 1.16. It is rarely adulterated. When subjected to analysis, it 
yields 88 per cent, of resin, 12 of benzoic acid, and a trace of volatile 
oil. Prolonged boiling in water removes from it the benzoic acid, but 
nothing else. 

It was at one time much used as an excitant, in external and internal 
ulcerations; and hence it has been prescribed as an expectorant in 
phthisis; in chronic bronchitis, and wherever a gentle excitant is needed. 
The dose is f.3ss to f.^i, dropped on sugar, mixed with molasses, or dif- 
fused in water by means of mucilage or yolk of egg. 

5. TOLUTA'NUM.— BALSAM OF TOLU. 

Balsam of Tolu is now considered to be the juice of Myrospermum 
or Myroxylon Toluiferum ; Sex. Syst. Decandria Monogynia ; Nat. 
Ord. Leguminosse, which is indigenous in the mountains of Tolu espe- 
cially. It is obtained by making incisions into the trunk of the tree, 
collecting the juice, as it exudes, in appropriate vessels, and allowing it 
to concrete. It is commonly imported in little calabashes ; and it does 
not appear to differ from the concrete white Peruvian balsam, which, 
as stated above, is termed balsam of Tolu. It is imported chiefly from 
Carthagena. 

When it first arrives in the country it is usually soft and tenacious ; 
but, when kept, becomes hard and brittle, somewhat like resin. It 
is transparent ; of a yellowish-brown colour ; has a highly fragrant odour, 
and a sweetish, not disagreeable taste. It is very soluble in alcohol, 
ether, and the essential oils ; and yields its benzoic acid to boiling 
water. Its chemical composition is similar to that of balsam of Peru. 

It is employed as an expectorant in the same cases as balsam of Peru, 
and is far more frequently prescribed. It has never appeared to the 
author to possess any special agency in chronic bronchitis ; but it makes 
an agreeable adjunct to cough mixtures in the form of Syrup of Tolu. 
In chronic catarrhal affections, the inhalation of the vapour of the ethe- 
real solution is said to have been of benefit. The dose is from gr. x. 
to gr. xxx. repeated from time to time. It may be given in the form of 
an emulsion made with mucilage of gum arabic. {Tolutan. Ji ; Mu- 
cilag. acacias f.5ss ; Syrupi f.3Hj ; Aquce f.5v. M.) 

TfflCTU'RA TOLUTA'NI, TINCTURE OF TOLU. {Tolutan. |iij. ; Alcohol. Oij.) 
This is sometimes added to pectoral mixtures, but is chiefly employed 
in the formation of the syrup. 



STYRAX. 



233 



SYRUTUS TOLUTA'NI, SYRUP OF TOLU. {Tinct. ToluL f.|i; Syrup. Oiss.) 
This is a very common adjunct to pectoral mixtures, to which it appears 
to communicate no virtues, but improves their flavour. Yet MM. 
Trousseau and Pidoux affirm, that they have cut short by it acute bron- 
chitis, " which had reached the first septenary," and which, they think, 
" would doubtless have gone on for a month or six weeks without the aid 
of this precious agent." In infants, it appeared to them of immense 
advantage in pulmonary catarrh, almost at the very onset of the affec- 
tion ; and still more " when the state of irritation, dryness and tumes- 
cence of the mucous membranes having been allayed, the catarrhal 
secretion began to be effected." 

Balsam of Tolu is an ingredient in Tinctura Benzoini Composita of 
the Pharmacopoeia of the United States. 

6. STYRAX.— STORAX. 



Storax is the concrete juice of Styrax officinale; Sex. Syst. Decan- 
dria Monogynia ; Nat. Ord. Styra- Fig. 4S. 

cese, (Lindley,) a small tree, which 
is indigenous in Asiatic Turkey and 
Greece, and is cultivated in the 
southern parts of Europe. From in- 
cisions made into the tree, or from 
the punctures of an insect, the storax 
exudes. No precise knowledge ex- 
ists as to the mode in which it is pro- 
cured, as the natives of the country, 
who collect it, will not communicate 
their mode of procedure. It is im- 
ported into Great Britain from Trieste. 
Two varieties are met with in the 
shops ; — common storax, — styrax ca- 
lami'ta of some, and liquid storax. 
The former occurs in brittle cakes, 
several pounds in weight, of a red- 
dish-brown colour, and having a fra- 
grant, agreeable, balsamic odour, and 
an aromatic taste. It appears to be 
composed of saw-dust, cemented by 
a resinous matter. It can be easily h Style " 
reduced to coarse powder, and in this state is often met with in the 
shops. The latter has been supposed to be derived by decoction from 
Liquidambar styraciflua ; but Dr. Wood remarks, that some of the 
genuine juice of Liquidambar, brought from New Orleans, which he 
had an opportunity of inspecting, had an odour entirely distinct from 
that of storax, and Dr. Griffith confirms the statement of their dissimi- 
larity from having had an opportunity of collecting the juice of the 
Liquidambar, which was widely different from any liquid storax he had 
ever seen. Moreover, it has been affirmed of late, that the liquid 
storax or storax oil is obtained at Cos and Rhodes from styrax officinale. 




Styrax officinale. 
Stamens and ovary. 



3. Fruit. 



234 SPECIAL EXPECTORANTS. 

By means of longitudinal incisions, the bark of the stems is removed in 
small narrow strips, which, when pressed together, readily adhere by 
means of their glutinous juice ; and in this way, they are made up in 
bundles of about two pounds each. These are then subjected to pres- 
sure in warm presses, by which means a liquid storax is obtained, 
which, according to Landerer, cited by Dr. Pereira, has the consistence 
of butter, a gray colour, and an odour resembling that of vanilla. It is 
doubtful, however, whether this is the liquid storax of the shops, which 
is of a brown, almost black colour On the surface exposed to the air, 
but of a light greenish-grey colour within and of a smell somewhat re- 
sembling that of the Balsam of Peru. 

Dr. Pereira has described not less than ten varieties, but the above 
are all that can concern the pharmacologist, — the others being rarely 
met with in commerce, and most of them never seen on this side the 
Atlantic. 

When subjected to analysis, storax yields a trace of volatile oil, about 
50 per cent, of resin, and one or two per cent, of benzoic acid, the 
presence of which entitles it to a place among the balsams. It is so 
mixed — in the state in which it is met with in the shops — with extra- 
neous matters, that it requires to be purified : this is done according to 
a process directed in the British and American Pharmacopoeias for 
STYRAX PURIFICA'TA, purified storax, which consists in dissolving the 
soluble matters in alcohol, straining the solution, - and distilling off the 
alcohol, until the storax acquires the proper consistence. The volatile 
portion is not driven off by the heat of boiling alcohol ; yet, as sug- 
gested by Dr. Christison, it may be well not to carry the concentration 
too far, in order that the fragrant principle may be better retained, and 
the extract be of a fitter consistence for forming pills. 

Like some of the articles already mentioned, it has been considered 
to possess "stimulant properties, which are more particularly directed 
to the mucous surfaces, especially to the bronchial membrane ;" but it 
may be doubted, whether either it or any of the articles referred to, be 
possessed of such powers. Like the other balsams, it is excitant, and 
might be employed in chronic catarrhal affections of the bronchia, in 
which excitant expectorants are needed. It is not often prescribed on 
this side the Atlantic, or indeed any where ; notwithstanding that the 
British colleges have a formula for the Pilulx Styracis Composite, 
which consist essentially of strained storax and opium, and are occa- 
sionally given in chronic pulmonary affections to relieve cough ; but 
are more valuable, perhaps, as a means of administering opium to per- 
sons prejudiced against it, the name and the balsamic character of the 
storax completely masking the narcotic. 

Should it be desired to administer storax, the dose may be ten to 
twenty grains, two or three times a day, — or common, or liquid storax 
may be suspended in water by means of mucilage of gum arabic. 

Storax enters into the composition of Tinctura Benzoini Composita 
of the Pharmacopoeias. 



BENZOINUM. 235 



7. BENZCINUM.— BEN'ZOIN. 

Benzoin or Benjamin is the concrete juice of Styrax Benzoin, Ben- 
jamin Tree; Sex. Syst. Decandria Monogynia; Nat. Ord. Styracese, 
— a tall tree, indigenous in Sumatra, Borneo, Siam and Java. It is 
obtained in Sumatra, when the tree is about six years old, by making 
incisions in the bark, and allowing the juice to remain for three months. 
Fresh incisions are made after the concrete juice has been removed, 
until the tree is exhausted, and usually dies. The juice which exudes 
at the first incision is the best, and said to be alone exported to Europe. 
Each tree yields about three pounds of Benzoin annually for ten or 
twelve years. 

Benzoin, met with in commerce, is usually imported into England 
from Singapore or Calcutta. In 1839, duty was paid there on 108 cwt. 
(Pereira.) It is of different degrees of fineness, and is sometimes dis- 
tinguished into firsts, seconds, and thirds ; or more commonly, perhaps, 
into firsts and seconds, or fine and coarse; and sometimes the finer 
kinds are termed Siam Benzoin ; the commoner, Calcutta Benzoin. 
The former contains white grains, which have the appearance of frag- 
ments of blanched almonds, that are seated in a deeper reddish-brown 
ground : the latter is more uniform, and has a dark-reddish brown or 
almost black colour. Both are firm and pulverizable ; of an agreeable, 
fragrant balsamic odour, and a slightly aromatic taste. Boiling water 
takes up a little benzoic acid ; alcohol dissolves all except the impuri- 
ties, and the solution is rendered milky by the addition of water. Its 
chief constituents are resin, benzoic acid, and a trace of volatile oil. 
The amygdaloid benzoin contains 80.7 per cent, of resin, and 19.8 
of benzoic acid ; the coarser or brown benzoin, 78.4 per cent, of resin, 
and 19.7 of benzoic acid. 

Benzoin had at one time a much higher reputation, as an internal 
remedy, than it has at present. Like the balsams and gum-resins, it 
was regarded as an excitant expectorant; and, as a relic of antiquity, it 
still holds its place in one or two formulae. Should it be prescribed at 
all, it ought to be in pulmonary affections, which are unaccompanied 
by febrile or inflammatory excitement. It will be seen afterwards, that 
it is employed as a topical expectorant in the form of fumigation ; and 
it is one of the ingredients of the fumigatory pastilles, which are largely 
used in oriental climes ; and of the fumigating compounds employed in 
the Romish church. 

It is scarcely ever or never administered in substance. The dose of 
the powder may be from ten to thirty grains. 

TINCTU'M BENZO'INI COMPOS'ITI, COMPOUND TINCTURE OF BENZOIN— {Ben- 
zoin, ^iij ; Styracis purificat. 5ij ; Tolutan. Jj. Aloes pulv. §ss ; Al- 
cohol. Oij.) The dose of this preparation, as an excitant expectorant, 
is f.Jss to f.3ij. It is rarely, however, employed. As the resin is pre- 
cipitated on the addition of water, it may be made into an emulsion by 
means of mucilage of gum arabic. It is chiefly used as an external 
excitant to ulcers. 



236 SPECIAL EXPECTORANTS. 

8. AC'IDUM BENZ(yiCUM.— BENZOIC ACID. 

Benzoic acid, formerly termed Flowers of Benjamin, exists in the 
various balsamic substances, as benzoin, storax, tolu balsam, &c. It is 
also met with in the vanilla pod, and in certain animal substances, as 
in the urine of children and of the herbivora under certain states of de- 
composition. In Pharmacy, it is obtained from benzoin by sublimation. 
Benzoin, in coarse powder, thoroughly mixed with an equal weight of 
fine sand, is put into a proper vessel, and, by means of a sand bath, 
with a gradually increasing heat, it is sublimed until vapours cease to 
rise. The sublimed matter is deprived of oil by pressure in bibulous 
paper, and is again sublimed. 

As met with in the shops, it is in light white feathery crystals, of an 
agreeable odour, and an acrid feebly acid taste. It is fusible, and 
wholly volatilizes if cautiously heated ; is soluble in about two hundred 
parts of cold water, and in about twenty-five parts of boiling water ; is 
very soluble in alcohol, and readily dissolves in solution of potassa, 
from which it is precipitated by chlorohydric acid. 

Its therapeutical action is, doubtless, excitant ; and it has been ima- 
gined by Dr. Pereira, and others, that its influence is principally 
directed to the mucous surfaces, and, " especially to the aerian mem- 
brane." The author has not had any reason for believing in this 
special affinity, and such would appear to be the general feeling of 
the profession, as it is now scarcely used except in one or two officinal 
preparations, in which it seems to be retained only from old preposses- 
sions and associations. 

When given alone as an exckant expectorant, its dose is from ten to 
thirty grains ; but the author has never administered it, or seen it ad- 
ministered, as such. It is occasionally used, as will be seen hereafter, 
as a topical expectorant ; and forms part of Tinctura opii camphorata 
or Paregoric elixir, in which it probably exerts little or no agency. 

9. COPA'IBA. 

Copaiba — whose general properties are described under Excitants — 
has been much extolled by many respectable practitioners in chronic bron- 
chitis, and in every form of pulmonary affection, in which a gentle ex- 
citant is necessary. It is not adapted for cases in which there is febrile 
or inflammatory action. Dr. La Roche, of Philadelphia, has adduced 
strong testimony in favour of it in diseases of the bronchial mucous 
memhrane of the atonic kind, as well as in diseases of the mucous 
membranes in general. It may be given in the dose of twenty or thirty 
drops on sugar, or be made into an emulsion. (Copaib. f.5iss; Mu~ 
cilag. Acacias f.3vj ; Syrup, f.^ss; Jiquce f.^ivss. — M. Dose, one 
fourth part, four times a day.) 

10. MYRRHA.— MYRRH. 

Myrrh is the concrete juice of Bahamodendron Myrrha ; Sex. Syst. 
Octandria Monogynia: Nat. Ord. Terebinthacese ; a small tree, which 



MYRRHA. 



237 




Balsamodendron myrrha. 
1, 2, 3. Balsamodendron kataf. 



is indigenous in Gison, on the borders of Arabia Felix. It exudes 
from the bark of the 

tree, and concretes . lg " 

there. Formerly, the 
finest kind of myrrh 
was imported from 
Turkey, and an in- 
ferior variety from 
India ; but it would 
seem that, at the 
present day, it al- 
most all comes from 
the latter country. A 
considerable quan- 
tity of it is con- 
sumed ; for, in the 
year 1839, accord- 
ing to Dr. Pereira, 
no less than 216 
cwt. paid duty in 
England. 

Myrrh of the shops is in irregular pieces of various sizes, differing 
in colour,— the best pieces being of a reddish-yellow, and translucent. 
It'is brittle, and- capable of reduction to powder, and has a peculiar, 
somewhat agreeable odour ; and a bitter aromatic, but, in the author's 
opinion, disagreeable taste. The best myrrh should possess these 
qualities ; but other varieties are occasionally met with, — a second 
quality, which is in distinct small tears or grains, — and a third quality, 
which occurs in pieces of a darker colour than the best, and which, • 
according to Dr. Pereira, are probably coarser myrrh mixed with 
impurities. 

Of the drug imported into this country from July, 1848, to April, 
1849, inclusive, Dr. Bailey, inspector of drugs at the port of New 
York, rejected 2,977 lbs. 

Myrrh is only partially soluble in water, alcohol, and ether : the gum 
enables the water to suspend a part of the resin. Dilute alcohol dis- 
solves some of the resin, and less of the gum ; whilst alcohol dissolves 
the resin and volatile oil, leaving the greater part of the gum ; and as 
the two first are the active ingredients in myrrh, alcohol is generally 
used as the menstruum. The most recent analysis afforded 2.6 per 
cent, of volatile oil, 27.8 of resin, and 63.7 of gum. 

It has been employed as an expectorant. From its constituents, it is 
obviously excitant, and, therefore, not adapted for any pulmonary affec- 
tion in which there is vascular excitement. It has been occasionally 
prescribed in the same cases as the other excitant expectorants, but is 
not much used at the present day ; and never, perhaps, except in com- 
bination. The dose is from gr. x. to gr. xxx. in the form of pill. It 
may also be made into an emulsion, but its taste is an objection to it in 
this form. 



238 SPECIAL EXPECTORANTS. 

TMCTU'RA MYRRHJ1, TINCTURE OF MYRRH. {Myrrh, contus. §iy ; Alcohol 
Oiij.) Tincture of myrrh possesses all the virtues of the drug, but it is 
scarcely ever prescribed internally. The dose, as an expectorant, is 
stated to be f.3ss to f.3j. 

Myrrh enters into the composition of various officinal formula?, as 
Mistura Ferri Composite; Pliluse Aloes et Myrrh se ; Pilulce Ferri 
Composite ; and Pilnlas Rhei Composite of the Pharmacopoeia of the 
United States. 

11. ASSAFCE'TIDA.— ASSAFETIDA. 

Assafetida, — whose general properties are described under Anti- 
spasmodics — is excitant, and therefore adapted for cases in which there 
is a want of due innervation in the respiratory apparatus, and, at the 
same time, no febrile or inflammatory action. In hooping-cough, it has 
been regarded as beneficial ; but the author has subjected it to exten- 
sive trials, and has not been able to say positively, that any markedly 
good effects have resulted from it. In this disease, it doubtless acts by 
virtue of the new T impression it makes on the nerves, and is more pro- 
perly an antispasmodic. In old cases of chronic bronchitis, and of 
chronic cough accompanied by nervous erethism occurring in any 
disease, it is prescribed. The dose is from gr. v. to ^ss. in the form of 
pill ; but it is rarely given alone, in this shape, as an expectorant. 

MISTU'RA ASSAFtE'TIM, ASSAFETIDA MIXTURE. (Assafcetid. £j ; Aqua 
Oss.) The gum of assafetida is sufficient to cause the suspension of the 
resin, so that Lac Assafcetidce—as it was formerly called— contains the 
main virtues of the gum-resin. In the thoracic affections for which 
assafetida is deemed proper, this is a good form of administration. 
For children, it may be sweetened with sugar; and although it may 
be disagreeable to them at first, they soon become accustomed to, and 
even fond of, it. The dose to an adult is f.^ss to f.5ij ; to a child, 
one or two tea-spoonfuls. 

12. GAL'BANUM. 

Galbanum, — whose general properties are described under Anti- 
spasmodics,— possesses the same excitant virtues as the other so- 
called 'antispasmodic' gum-resins; and is presumed to hold an in- 
termediate place between ammoniacura and assafetida as an expecto- 
rant. It is very rarely, however, used as such ;— on this side of the 
Atlantic, never perhaps. The dose is from gr. x. to xxx. in the form 
of pill ; or made into an emulsion. 

13. AL'LIUM.- GARLIC 

The bulb of Allium Sativum, Sex. Syst. Hexandria Monogynia ; 
Nat. Ord. Liliacese (Lindley), is a well known culinary article, and 
although not much used in medicine is introduced into the Pharma- 
copoeias of Great Britain and this country. Garlic is indigenous in the 



• INULA. 239 

Southern countries of Europe, flowering in July ; and is every where 
cultivated in the kitchen gardens. 

The strong, peculiar, irritating smell, and acrid taste of garlic are 
owing to volatile oil, separable by distillation with water, — six drachms 
being obtained from twenty pounds of garlic. An acrid expressed oil 
can also be separated from it. The volatile oil has a very acrid taste ; 
and strong smell. 

Like all substances whose medicinal virtues are dependent upon 
volatile oil, ga*rlic is excitant ; and consequently, when employed as an 
expectorant, it can only be in cases where there is no active inflamma- 
tion of the lining membrane of the bronchial tubes; and in states of the 
system andof the tubes, in which a gentle excitant is necessary, as in 
chronic bronchitis. In such cases, the expressed juice may be mixed 
with sugar ; or the following preparation may be advised : 

SYRU'PUS AL'LE, SYRUP OF GARLIC. (Mii recent. §vj ; Meet destillat. 
Oj ; Sacch. fgij ; f. syrupus.) The vinegar is used in this preparation 
under the idea, that it is a better solvent of the active principle than 
water, — which may be questioned. It is occasionally given to children 
affected'with ordinary catarrh, in the dose of a tea-spoonful or two, but 
is not much prescribed by the physician. It is an officinal preparation 
in the Pharmacopoeia of the United States, but not in that of any British 
College. 

14. IN'ULA.— ELECAMPANE'. 

Elecampane is the root of Inula Helenium, Sex. Syst. Syngenesia 
Polygamia Superflua : Nat. Ord. Composite Asteroideae ; a large hand- 
some plant, which is indigenous in various parts of Europe ; flowering 
in June and July. It has become naturalized in this country, and is 
cultivated in the gardens, and for medical use. The root is officinal in 
the secondary list of the Pharmacopoeia of the United States. 

As met with in the shops, the dried root is usually in longitudinal or 
transverse slices, of a yellowish-gray colour, an aromatic slightly cam- 
phoraceous odour, and a warm, aromatic and bitter taste. The medical 
virtues are imparted both to alcohol and water. The root has been 
analyzed by different chemists, and found to contain, amongst other 
constituents, a peculiar aromatic principle, to which the names Helenin 
and Elecampane Camphor have been given; resin, the taste of which 
is bitter, nauseous and acrid ; an amylaceous substance termed Inulin 
and Mantin; and bitter extractive. From this analysis it can be un- 
derstood that Inula possesses the medical virtues of the aromatic tonics ; 
but it is rarely used except as an excitant expectorant in pulmonary 
catarrh, and bronchitic affections, in which there is no febrile or in- 
flammatory excitement. It has had some reputation as an emmena- 
gogue, but has outlived it. It may, like other aromatic tonics, act 
indirectly in asthenic cases of amenorrhoea. The decoction is the form 
commonly prescribed. [Inul. 5ss; Jlqua Oj. — Dose, f.5i to f.5ij.) 



240 SPECIAL EXPECTORANTS. * 

15. CREASO'TUM.— CRE'ASOTE. 

Creasote — whose properties are described under Excitants — has 
been used as an excitant expectorant in phthisis ; but the results have 
been discordant, as might have been anticipated in so intractable a 
disease. On the whole, its employment has been productive of but 
little advantage. It is probable, however, that where there is much 
secretion from the bronchial mucous membrane it may be of service ; 
yet in these cases, Tar-water — Aqua picis liquidse, which is probably 
mainly indebted for its efficacy to the creasote it contains — has been 
preferred by some. 

When in the distillation of coal tar, the last portion of the volatile 
oily product is collected apart and left to stand, a quantity of solid, 
crystalline matter separates, which is principally composed of Naph'- 
thaline. This substance forms large, colourless, transparent, brilliant, 
crystalline plates, that exhale a faint and peculiar odour which has been 
compared to that of narcissus. It melts at 176°, and boils at 413°. It 
is insoluble in cold water ; but soluble to a slight degree at a boiling 
temperature. Alcohol and ether dissolve it readily. It has been given 
by M. Dupasquier as an excitant expectorant in chronic bronchitis, in 
the dose of from 8 to 30 grains in emulsion or syrup, repeated at inter- 
vals of a quarter of an hour, until a copious expectoration supervenes. 
In psoriasis and lepra vulgaris, an ointment composed of two parts 
of concrete naphthaline to 30 of lard, proved successful, according to 
M. Emery. 

Under the names Naphtha, and Wood Naphtha, the Pyroace'tic 
spirit, Pyroace'tic ether or %ftc'[etone has been recommended in pulmonary 
consumption by Dr. Hastings and others; but the evidence is far from 
establishing that it is possessed of more efficacy than creasote and the 
articles just mentioned. It is obtained by carefully distilling a mixture 
of crystallized acetate of lead and quick-lime, and rectifying the crude 
spirit by repeated distillations from quick-lime. It is a colourless lim- 
pid liquid, having a peculiar odour ; a density of .792, and boils at 
132°. As found in the shops, its density, according to Dr. Bache, is 
generally not lower than .820. It mixes with water, ether and alcohol 
in all proportions. The dose in which it was used by Dr. Hastings — 
who proposed it as a cure for pulmonary consumption on very inade- 
quate grounds, however — was from ten to forty drops, three times a day. 

Like creasote, it may be found serviceable in chronic bronchitis, 
where an excitant expectorant is needed. (New Remedies, 5th edit. p. 
558, Philad. 1846.) 

II. Demulcent Expectorants. 

16. ACA'CIA.— GUM AR'ABIC 

Gum Arabic is the concrete juice of Acacia vera, and other species 
of Acacia : Sex. Syst. Polygamia Moncecia ; Nat. Ord. Leguminosse. 



ACACIA. 241 

The species of Acacia, that yield considerable quantities of gum, are 
besides Acacia vera, a native of Arabia and of Africa from Senegal to 
Egypt, — Acacia Arabica, a native of Senegal, Egypt, Arabia and India ; 
A. Karoo, indigenous at the Cape of Good Hope ; A. gummifera, na- 
tive of Arabia and of Africa, near Mogadore ; — A. Seyal, native of 
Egypt and Senegambia ; A. tortilis, and A. Ehrenbergii, natives of Ara- 
bia,; and A. Senegal, native of Arabia, and 
Africa from Senegal to the Cape of Good 
Hope. The gum generally exudes from 
the Acaciee spontaneously, and concretes 
On the trunk and branches. At times, how- 
ever, incisions are made to facilitate its 
flow. It commonly exudes soon after the 
rainy season has softened the bark, and 
made it liable to split during the succeed- 
ing hot weather. It is exported to this 
country from the Levant, or some of the 
other parts of the Mediterranean ; from 
Barbary and Senegal, and from the East w Acacia ^^ % 
Indies, Cape of Good Hope, &c. Accord- 
ing to Dr. Pereira, duty was paid, in 1839, on the following quantities 
imported into England. 

Gum from the East Indies, - 7,869 cwts. 

Senegal Gum, - - ' - - - - 24,698 
Other sorts of Gum, ----- 7,759 




Total, , - 40,326 

The best gum arabic, often termed Turkey gum, is in rounded, or 
amorphous pieces ; some of them transparent ; others more or less 
opaque, with deep cracks extending through them. It is usually of a 
white or yellowish-white colour. The powder into which it is readily 
reduced is generally almost pure white. It is inodorous, and has a very 
feeble taste. Its specific gravity varies from 1.316 to 1.482. It is 
wholly soluble in water, forming a mucilage, which is an officinal pre- 
paration. It is insoluble in alcohol, which throws it down from its 
aqueous solution. 

These are the main qualities of the officinal gum arabic. It is apt, 
however, to be mixed with other varieties of gum, which are described 
by the different writers on pharmacology, but which demand no detailed 
account here; — for example : 1. The Barbary or Morocco Gum, 
supposed to be the produce of Acacia gummifera, which is imperfectly 
soluble in water : 2. Gum Senegal, obtained from several species of 
acacia, which is by no means as easily pulverized as the best gum 
arabic. 3. East India Gum, some of which resembles the best gum 
arabic ; but other portions are far more difficult to pulverize ; and 4, 
Cape Gum, which is of a very inferior kind. 

Gum arabic has been subjected to analysis by Guerin, and found to 
consist of 79.40 per cent, of pure gummy principle, to which the name 

Vol. I.— 16 



242 



SPECIAL EXPECTORANTS. 



Arabin has been given, and which is wholly soluble ; of 17.60 per 
cent, of water, and 3.00 of ashes. It contains no Bassorin or insolu- 
ble gum, which exists in such large quantities in Gum Bassora, 
supposed to be the concrete juice of a mesembryanthemum. 

The essential action of gum arabic is that of a demulcent to the sur- 
faces with which it comes in contact, — soothing the top of the larynx 
in catarrhal affections, and the soothing influence being extended down- 
wards along the trachea and bronchia by continuous sympathy. It is 
sometimes taken into the mouth in those affections, and permitted to 
dissolve slowly ; and it is the basis of certain lozenges, which have 
attained celebrity for relieving cough, and facilitating expectoration. It 
is a valuable agent in many cough mixtures into which fixed oil enters 
— not simply as a demulcent expectorant, but to suspend the oil in water, 
and form it into an emulsion. The dose of the powder has been stated 
at from 3ss to 3j ; but it is obviously an article the dose of which can 
scarcely be fixed. It is taken ad libitum. 

MUCIM'GO ACA'M, MUCILAGE OF GUM AR'ABIC. {Acacia pulv. giv. Aqua 
bullientis Oss.) It forms parts of many mixtures for relieving cough ; 
but is chiefly used as a vehicle to render other substances miscible with 
water. 



17. ALTHiE'A.— MARSHMAL'LOW. 

Marshmallow is the root of Althcea officinalis ■, Sex. Syst. Monadel- 
Fig. 5i. phia Polyandria ; Nat. Ord. Malva- 

ceae ; an herbaceous perennial, which 
is indigenous in this country as well as 
in Europe, growing on the borders of 
marshes, and especially of salt marshes. 
The roots are collected in autumn ; 
but those that are met with in the 
shops are chiefly obtained from Europe. 
They are generally deprived of epider- 
mis, and are of a white colour ; cylin- 
drical shape ; and of about the thick- 
ness of the little finger. Their odour 
is feeble ; taste sweet and mucilagi- 
nous. They are light ; woolly exter- 
nally, and composed of delicate silky 
fibres. When chemically examined, 
they are found to contain a little 
fecula or starch ; nearly 20 per cent, 
of mucilage ; some uncrystallizable, 
sugar ; and a crystallizable principle, 
identical with the asparagin of aspa- 
ragus, — besides other less important 
•constituents. 

The virtues of marshmallow are similar to those of gum arabic ; and 
it has been employed in the same cases, especially on the continent of 




Althaea Officinalis. 

Styles. 2. Stamens. 3. Outer calyx. 
4. Inner calyx. 



AMYGDALA. 243 

Europe. The Pate de Guimauve or Marshmallow Paste or Lozenge is 
a favourite remedy in France in hoarseness, and catarrhal affections in 
general. 

There is no officinal preparation of althaea in the Pharmacopoeia of 
the United States : a Decoction is officinal in the Edinburgh and Dub- 
lin Pharmacopoeias, and a Syrup in all the British. 

18. AMYG'DALA.— MALONDS. 

The Pharmacopoeia of the United States, as well as those of Great 
Britain and elsewhere, admit both the bitter and the sweet almonds as 
officinal,— the former being the kernels of the fruit of Jlmygdalus com- 
munis, — variety amara ; and the latter of Jimygdalus communis, — 
variety dulcis ; a tree in Sex. Syst. Icosandria Monogynia ; Nat. Ord. 
Rosaceae (Jussieu), — Tribe, Amygdalese, which is indigenous in Barbary 
and Syria, and is cultivated in the southern parts of Europe, whence it 
has been introduced into this country, but without any advantage, ex- 
cept as an ornament. The general opinion is, that both varieties of 
almonds are furnished by a tree of the same species ; some botanists, 
however, believe that they are produced by distinct species, and Nies 
von Esenbeck states, that he had been informed on good authority, that 
in the Palatinate bitter almonds are not unfrequently gathered from the 
sweet almond tree, (Christison.) 

The almond is so well known as not to require a description. Sweet 
Almonds are imported from Spain and the south of France. The Jor- 
dan Almonds, which are best, come from Malaga ; other varieties, — 
according to Mr. Busby, — are the Valentia, Barbary, and Italian. 
Bitter almonds are brought chiefly from Mogadore. One variety only is 
known in commerce. Both sorts, when triturated with water, furnish a 
copious white emulsion. 

The composition of the sweet and bitter almond is interesting to the 
chemist ; but not much so to the therapeutist. The sweet almond con- 
tains about 54 per cent, of a bland fixed oil — Oleum Amygdala, — 
24 per cent, of a variety of soluble vegetable albumen, termed emulsin 
or synaptase, which is the principle that suspends the oil in almond 
emulsion ; sugar; gum ; moisture and integuments. The bitter almond 
contains rather less fixed oil and more synaptase, and has, besides, a 
peculiar principle, called Jlmygdalin, which is interesting in its chemi- 
cal, but not in any therapeutical relation. It contains, moreover, the 
elements of a bitter volatile oil, which does not exist in the bitter almond, 
but is speedily developed when water comes in contact with it. It has 
been found, that when bitter almonds are deprived of their amygdalin, 
they are incapable of yielding volatile oil ; hence it has been inferred, 
that water acts upon this principle and generates the oil. Yet amygda- 
lin and water produce no oil, unless emulsin or synaptase be likewise 
present. ^ Certain it is, that bitter almonds yield no volatile oil on pres- 
sure, which ought to be the case did .it exist in them ; as the volatile 
oil is soluble in the fixed oil ; nor do they yield oil to alcohol or ether. 
This oil is highly poisonous, and contains hydrocyanic acid, for which 
— as elsewhere shown — certain preparations from the bitter almonds are 



244 



SPECIAL EXPECTORANTS. 



occasionally used as substitutes. Amygdalin does not appear to be 
poisonous when taken pure into the stomach, as there is nothing in that 
organ capable of acting the part of emulsin. It is said, however, that 
large quantities given to dogs have produced narcotic effects. 

Both varieties of almonds are demulcents by virtue of the oil they 
contain, and it has been conceived, that the volatile oil, developed by 
the combination of water, amygdalin and emulsin, may communicate to 
the emulsion of bitter almonds virtues similar to those of hydrocyanic 
acid, and not possessed by the emulsion of sweet almonds ; — and hence, 
that the former may be adapted for cases in which a demulcent expec- 
torant is needed equally with hydrocyanic acid. Often, however, the 
bitter almond, in pharmaceutical as in culinary preparations, is em- 
ployed solely to communicate an agreeable flavour to the compound. 

fflSTU'RA AMYGDALA, ALMOND MIXTURE. {Amygdal. dulc. Ess; Acacia 
pulv. £ss ; Sacchar. £ij ; Aquae destillat. f.^viij.) Almond mixture is 
an elegant demulcent expectorant, much prescribed for allaying cough 
in catarrhal affections, under the name of almond emulsion and almond 
milk. It is a good vehicle for the administration of other agents, as 
laudanum, paregoric, antimonial wine, &c. It maybe taken almost ad 
libitum ; but the ordinary dose is from f.5j to f-§iij- 

SYRUTUS AMYGDALA, SYRUP OF ALMONDS. {Amygdal dulc. $j ; Amyg- 
dal. amar. 5iv; Aquae, Oiij ; Sacchar. fgvj.) This is syrup of orgeat , 
which has been introduced from the French Codex into the last edition 
of the Pharmacopoeia of the United States. It may be used in the same 
cases as almond emulsion, and is an agreeable drink in sickness. 

19. C/LEUM AMYG'DALjE.— OIL OF ALMONDS. 

Almond oil is the fixed oil of the kernels of Amygdalus communis. 
(p. 243.) It is obtained by expression from either bitter or sweet al- 
monds, but more commonly from the former, on account of their 
cheapness, as well as the greater value of their residuary cake. The 
average produce is from 48 to 50 lbs. from one cwt. of almonds. From 
what has been said before, it will be obvious, that in the case of 
bitter almonds the contact of water must be avoided. As met with in 
the shops, oil of almonds is transparent and without colour, or of a 
slightly yellow tinge; nearly inodorous, and of a bland, oleaginous taste. 
It is soluble in ether, and in six parts of boiling, or twenty-five parts of 
cold, alcohol. Its density varies from .917 to .920. The cake, left 
after the expression of the oil, when ground, forms Almond powder, 
which is used for keeping the skin of the hands soft. 

Almond oil is sometimes prescribed in the form of the common olea- 
ginous mixture in cases of catarrh, as a demulcent expectorant. (Olei 
amygdal. f.Jiij ; Mucilag. acacice ; Syrup, aa f.§ss; Aquas f.^ivss. M. 
Dose, a table-spoonful, when the cough is troublesome.) To this mix- 
ture may be added sulphate, acetate, or muriate of morphia, or Tinctura 
opii camvhorata, &c, according to the indications. An emulsion 
might also be made by the substitution of alkalies, or of the yolk of 



OLEUM OLIVJE. 



245 



egg, for the mucilage; but neither is so agreeable. Formerly, equal 
parts of syrup of violets or syrup of roses, and of almond oil, was a favour- 
ite laxative mixture for infants, and it has been used in the catarrhal 
affections of that age, — simple syrup being substituted for either of the 
syrups mentioned. Atone time, almond oil was more frequently employed 
than at present in the formation of linctuses to allay cough. Of these, 
the following is a form; 'R.^-Confect. Rosa canin. §j ; Syrup Papa- 
veris ; 01. amygdal. aa f.^ss. M. Dose ; a tea-spoonful or two when 
the cough is troublesome.) These linctuses are rarely employed, at 
the present day, in this country. 

20. O'LEUM OLI'V^.— OLIVE OIL. 

Fig. 52. Olive oil is the expressed oil of the 

fruit of Olea Europcea, European olive ; 
Sex. Syst. Decandria Monongynia ; 
Nat. Ord. Oleaceae ; a tree which 
is supposed to have been originally 
from Asia, but has been cultivated, 
as far as history extends back, in the 
south of Europe. 

The finest oil is obtained from ripe 
olives, by crushing them immediately 
in a mill, and subjecting the pulp or 
pericarp to gentle pressure. By aug- 
menting the pressure, a somewhat in- 
ferior — but still good — article is ob- 
tained. An inferior kind is got by 
pouring boiling water on the residuum, 
to dissolve its mucilage ; and subject- 
ing it again to gentle pressure ; and 
a still stronger pressure forces out a 
turbid, impure oil, which is fit only 
for the soap-maker. An inferior oil 
is likewise obtained by allowing the 
olives to ferment for some days before they are subjected to pressure. 
The most esteemed oil is that made in Aix, and termed Provence Oil. 
Florence Oil or Salad Oil is a fine kind, imported from Leghorn in 
flasks. Genoa Oil is likewise a fine variety. The Gallipoli Oil, 
Sicily Oil, and Spanish Oil, are inferior varieties; the last being 
esteemed the worst of all. 

The quantity of olive oil consumed is very great. In the year 1839, 
duty was paid in England on 12,374 tons. It is an article so well 
known as not to need any description. When good, it is almost devoid 
of smell, and has a bland, slightly sweet taste. Its density at 77° Fahr. 
is about 0.911. It is soluble in one and a half times its weight of 
ether ; and very slightly soluble in alcohol. By exposure to air, it 
readily becomes rancid, but more slowly than other fixed oils. It is 
said to be much subject to adulteration with poppyseed oil, rapeseed 
oil and other cheap oils ; but as these oils congeal less readily than olive 




Olea Europeea. 
1. Corolla. 2. Calyx. 3. Drupe. 



246 



SPECIAL EXPECTORANTS. 



oil, the adulteration may be detected by reducing the temperature to the 
freezing point ; or, the test suggested by M. Poutet, and adopted by the 
Edinburgh Pharmacopoeia, may be used. When pure olive oil is mixed 
•with a solution of mercury in nitric acid prepared by heat, the whole 
becomes, in a few hours, a firm fatty mass from the action of the hypo- 
nitrous acid in the solution. But if even so small a quantity as 5 per 
cent, of any other oil be present, the consolidation is much more firm 
and more tardy ; and if the proportion amounts to 12 per cent., the 
foreign oil floats on the surface of a pulpy mass for several days before 
showing any tendency to concrete. According to M.Diesel, pure olive 
oil is coloured green by common nitric acid ; but if mixed with rape 
oil it is rendered of a strong yellowish-gray colour. 

As a demulcent expectorant, olive oil is used in the same cases and 
form of preparation as almond oil. 

21. CETA'CEUM.— SPERM ACET'I. 

Spermaceti is a peculiar concrete substance, approaching in character 
the concrete fixed oils or fats, which is obtained from Physeter Macro- 
cephalus, great-headed Cachalot or spermaceti or sperm whale, order 
Cetacea, which inhabits the Pacific ocean, and the Indian and Chinese 
seas. It is found in various parts of the animal's body, being dissolved 
in small proportion in the blubber. The head, however, contains that 
which we meet with in commerce: It is mixed with oil, in a large 
cavity in the upper jaw, anterior to, and quite distinct from, the cavity 
that holds the brain. There are two places in the head, which contain 
it, between which the nostrils pass ; and both cavities are divided into 
numerous cells, which are filled with a milky fluid, amounting, in a 
large whale, to about 50 cwt. The contents of these cavities are re- 
moved by buckets, and boiled, to separate the oleaginous from the solid 
matter. In this fluid, the spermaceti crystallizes as it cools, and is sepa- 
rated in an impure state by draining off the oil, and subjecting what re- 
mains to strong pressure. The crude spermaceti is purified by melting 
in water, and skimming off the impurities. It is then melted in a weak 
solution of potassa, and finally melted a third time by. a gentle heat ; 
after which it is solidified in proper moulds, when it forms the sperma- 
ceti of the shops. It generally contains a small portion of oil, which 
may be removed by boiling in alcohol. The spermaceti, then called 
cetin, is absolutely pure. 

Spermaceti of the shops is a white concrete substance, of a foliaceous 
texture^^without taste, and almost without smell. It may be readily re- 
duced to powder by the addition of a few drops of rectified spirit. It 
is insoluble in water ; slightly soluble in cold alcohol, but greatly so 
when the alcohol is at the boiling temperature. It is very soluble in 
ether, and readily so in the oils — fixed or volatile. It possesses the 
demulcent properties of the bland fixed oils ; but is rarely given in- 
ternally. When this is desired, it may be made into an emulsion with 
yolk of egg, or mucilage, the spermaceti being first pulverized by the 
addition of a few drops of alcohol. 



SACCHARUM. 



247 




Saccharum ofllcinarum. 



22. SACCHARUM.— SUGAR. 

This, in the Pharmacopoeia of the United Fig- 53. 

States (1842), is the officinal name for the refined 
sugar of Saccharum officinarum, Sugar cane. 

Saccharum qfficinarum ; Sex. Syst. Triandria 
Digynia ; Nat. Ord. Graminese, is cultivated in 
the tropical regions of both the old and the new 
world. Its native country cannot now be dis- 
covered ; but it is supposed to have come origi- 
nally from the East. It is the expressed juice of 
the ripe canes, clarified and allowed to crystallize 
or grain. The sugar, when put in casks and 
allowed, to drain, forms Muscavado, brown, or 
raw sugar ; and the uncrystallized portion is 
molasses. Six pounds of juice, in the East In- 
dies ; and eight pounds in the West Indies, ac- 
cording to Dr. Christison, yield one pound of raw sugar. 

Raw sugar contains various impurities, from which it can be sepa- 
rated by elutriation with a little water, solution in water heated by 
steam, clarification with blood and alumina, filtration through animal 
charcoal, concentration in vacuo at 150°, cyrstallization, and displace- 
ment of the impure syrup in the crystalline mass by passing pure syrup 
through it. (Mr. Howard, cited by Dr. Christison.) The product is White 
Sugar, Refined Sugar, or Loaf Sugar — Saccharum of the Pharma- 
copoeia of the United States — of which 79 per .cent, may be obtained 
from good Muscavado sugar. The uncrystallizable syrup in this process 
is Treacle or Sugar-house Molasses. 

It is not necessary to describe further the processes for forming various 
kinds of sugar ; or to dwell upon its properties. It may be well, how- 
ever, to remark, that by the slow evaporation of a solution of sugar in 
water, a crystalline product results, called Sugar Candy. Barley 
Sugar is obtained by evaporating syrup to a state of great concen- 
tration, taking care not to empyreumatize it; and then allowing it to 
cool. Taffy is made by evaporating a mixture* of sugar and butter ; 
and Candy by boiling syrup or molasses for a few minutes, with the 
addition of a little butter to prevent it from burning, and flavouring with 
lemon, peppermint, &c, should this be desirable. 

Sugar is very soluble in water; and its saturated solution, called 
Syrup, is an officinal preparation. It is also soluble in alcohol ; but 
not in ether. 

It is one of the best of the demulcent expectorants, and on that ac- 
count forms a part of most cough mixtures. In the shape of candies, 
lozenges, &c, it is much used in cases of tickling cough. A mixture 
of syrup and olive oil in equal portions is a common prescription in the 
catarrhal affections of infants ; and the various officinal syrups that are 
used as expectorants, as Syrupus, Syrupus allii, Syrupus amygdala, Sy- 
rupus scillce, S. Scillce, compositus, S. senegcs, and S. tolutani, owe a con- 
siderable part of their efficacy to their saccharine constituent. 



248 



SPECIAL EXPECTORANTS. 



SYRUTUS, SYRUP. (Sacchar. fgiiss ; Aqua Oj.) Simple Syrup is rarely 
used alone as a demulcent expectorant, but it forms part of many mix- 
tures that are prescribed for allaying cough. 

23. GLYCYRRHI'ZA.— LIQTJORICE ROOT. 

Fig. 54. Liquorice root is the root 

of Glycyrrhiza glabra, 
Common Liquorice; Sex. 
Syst. Diadelphia De- 
candria ; Nat. Ord. Le- 
guminosae ; a perennial 
herbaceous plant, which 
is indigenous in the 
south of Europe, and is 
cultivated at Mitcham, 
in Surrey, England, and 
at other places, for me- 
dicinal use. Much of 
the root which is im- 
ported into this country 
is said to come from the 
ports of Messina and 
Palermo in Sicily. 

Liquorice Root, Stick 
Liquorice of the shops, 
is in long cylindrical 
pieces of varied thick- 
ness, from a few lines 
to more than an inch ; 
Glycyrrhiza glabra. of a grayish-brown co- 

lour externally, and yel- 
low internally. It has little or no odour, but a remarkably sweet taste, 
with a slight degree o'f acrimony. Its main chemical constituents are 
Glycyrrhizin, Glycion or Liquorice Sugar, which belongs to the uncrys- 
tallizable sugars, that are not susceptible of vinous fermentation ; and a 
resinous oil, to which it owes the slight degree of acrimony which it 
possesses. The acridity seems to be seated in the epidermis, so that, 
for medical use, the epidermis should be removed. The active princi- 
ple is soluble in water. 

It is one of the most agreeable demulcent expectorants, and is gen- 
erally given in the form of decoction, either alone or combined with 
other demulcents. It is not often, however, prescribed by the practi- 
tioner ; and as a domestic remedy is more used in the form of the 
extract. It enters into the composition of Confictio Sennce, De^coctum 
Sarsaparillce Compositum, Injusum Lini, Pilulce Hydrargyria and Sy- 
rupus Sarsaparillce Compositus of the Pharmacopoeia of the United States. 




EXTRAC'TUM GLYCYRRHI'ZiE, EXTRACT OF LIQUORICE, Liquorice Juice, 



LINUM. 249 

Spanish Juice, Italian Juice, Black Sugar, is amongst the preparations in 
the London and Dublin Pharmacopoeias ; but as it is altogether im- 
ported into this country, it has been properly placed in the Materia 
Medica list of the Pharmacopoeia of the United States. It is prepared 
in the same manner as the ordinary watery extracts, by boiling the root, 
and evaporating the strained decoction. Spanish juice is said to be 
prepared in Catalonia from Glycyrrhiza glabra; in Italy, from G. 
echinata. About 4,059 cwt. of foreign extract of liquorice, according 
to Dr. Pereira, paid duty in England in the year 1839. 

That which is used in this country is said to be brought from Leg- 
horn and Messina. It comes in cylindrical or flattened rolls, covered 
with bay leaves, and when good is very black, dry, brittle, and entirely 
soluble in water. It is rarely, however, wholly pure, as usually met 
with. Refi'ned liquorice is obtained by dissolving the imported ex- \ 
tract in water, filtering the solution, and evaporating. The Ponte- J 
fract or Pomfret Lozenges are made of refined liquorice. ~s 

Extract of liquorice is taken into the mouth, and allowed to dissolve 
slowly as a demulcent expectorant in cough. 

TROCHIS'CI GLYCYBirarZJ] ET O'PII, TROCHES OF LIQUORICE AND OPIUM. 
(Opii pulv. §ss; Glycyrrhiz. pulv., Sacchar. pulv., Acacice pulv. aa 
§x; 01. Anisi f.%1).) These lozenges combine the demulcent virtues 
of liquorice, sugar, and gum arabic; and the anodyne properties of 
opium. They are, consequently, well adapted to allay cough, where 
opium is admissible. Each lozenge contains about one-seventh of a 
grain of opium. 

A preparation similar to these troches is known in Philadelphia under 
the name of Wistar^s Cough Lozenges. 

24. LINUM.— FLAXSEED. 

Flaxseed, Linseed or Lintseed is the seed of Linum usitatissimum, 
Common flax ; Sex. Syst. Pentandria Pentagynia ; Nat. Fig. 55. 

Ord. Lineae, — Linaceae, (Lindley,) an annual plant, 
extensively cultivated in various parts of the globe, 
which flowers in June and July, and whose seeds ripen 
in August. Both the seeds and their expressed oil 
are officinal. The seeds are oblong, oval, flattened on 
the sides, with acute edges, pointed at one end, smooth, 
glossy, brown externally and yellowish-white within, 
devoid of smell, and of an oily mucilaginous taste. 
The coat of the seeds is mucilaginous ; the nucleus 
oily. The entire seed yields about a sixth of dry mu- 
cilage, and a fifth of oil. Linseed meal is the oil cake, 
which remains after the expression of linseed oil ground 
to powder. It abounds in mucilage, and is extensively 
used in the formation of poultices. For this purpose 
it is better than the ground seeds, which contain oil, Linum usitatissimum. 
and are liable to become rancid. 

Flaxseed is not given in substance. The most common form of ad- 
ministration as a demulcent expectorant is the 





250 SPECIAL EXPECTORANTS. 

INFU'SUM LINI, INFUSION OP FLAXSEED. (Zinigss; Glycyrrhiz. cont. 
3ij ; Aquas bullient. Oj.) Flaxseed tea is a common domestic remedy 
in catarrhal affections. The formula given above is officinal in the 
Pharmacopoeia of the United States. It is rendered more palatable by 
the addition of sliced lemon. The dose may be from f.^ij, to f.^iv ; 
but it is generally taken ad libitum. 

25. TRAGACAN'THA.— TRAG'ACANTH. 

Tragacanth or Gum Tragacanth or Gum Dragon is referred to As- 
tragalus verus by the Pharmacopoeia of the United States (1842); but 
Fi 56 it is generally supposed to be the concrete 

juice of various species of Astragalus ; Sex. 
Svst. Diadelphia Decandria ; Nat. Ord. 
Leguminosse. The greater part, however, 
of that which is met with in commerce 
would seem to belong to Astragalus verus, 
a native of Persia. Astragalus gummifer 
, of Lebanon ; A. Creticus of Mount Ida in 
Crete, and A. strobiliferus of Koordistan 
are also said to produce it. It exudes 
spontaneously from the stems and branches 
Astragalus verus. during the summer season ; and concretes 

there. It is imported from Smyrna and other ports of the Levant. The 
entries of tragacanth for home consumption, in Great Britain, in 1831 
and 1832, were, according to Mr. M'Culloch, at the rate of 45,836 lbs. 
a year. 

As seen in the shops, it is in small contorted pieces of the most irre- 
gular shapes; of a yellowish-brown colour; semi-transparent or trans- 
lucent; hard; tough; devoid of odour and taste; difficult of pulveriza- 
tion, except at a temperature of between 100° and 120° Fahr., 
(Christison), or at a freezing temperature, (Wood & Bache.) Its 
specific gravity is 1.384. With cold water as well as hot it forms a 
mucilage ; but a portion only appears to be dissolved ; the remainder, 
after a time, being precipitated. Chemical analysis shows it, indeed, 
to be composed of common gum, identical with, or at all events re- 
sembling, the Arabin of gum arabic, which has been termed Traga- 
canthin or A dragantin, soluble gum or Arabin of tragacanth ; and of 
Bassorin or insoluble gum of tragacanth ; the former, according to one 
analysis, constituting 57 ; the latter 43 per cent. Gum tragacanth is 
wholly insoluble in alcohol. From its property of swelling up in water, 
and forming a soft adhesive paste, it is much used in the shop of the 
apothecary for pasting labels, &c. 

Dr. Pereira describes two kinds of tragacanth, — Flaky or Smyrna 
Tragacanth, — that usually found in English commerce, and which 
occurs in moderately large, broad, thin pieces, marked with arched or 
concentric elevations : and the Vermiform or Morea Tragacanth, 
common on the continent of Europe, and occurring in small, twisted, 
filiform, spiral pieces. 

Tragacanth possesses the same properties as gum arabic, but it is 



SASSAFRAS MEDULLA. 251 

very rarely employed as a demulcent. It is more commonly used as a 
means of administering heavy powders by reason of the great viscidity 
it imparts to water ; and, in pharmacy, in the formation of troches or 
lozenges. Should it be desirable to administer the powder, the dose 
may be from Jss to £ij. Pulvis TRAGACANTHiE Composite s of the 
London and Edinburgh Pharmacopoeias, which consists of tragacanth, 
gum arable, starch, and sugar, is chiefly used as a vehicle for the ex- 
hibition of heavy active powders to children ; and is occasionally given 
as a demulcent. 

BtUCILA'GO TRAGACAN1M, MUCILAGE OF TRAG'ACANTH. {Tragacanth. §i; 
Aquse bullient. Oj.) This mucilage is rarely given internally. It is 
chiefly used in pharmacy in the formation of troches or lozenges, as of 
Trochisci ipecacuanha?, T. magnesias, and T. menthce piperitae of the 
Pharmacopoeia of the United States. 

26. SES'AMUM.— BENNE. 

Benne, which is in the secondary list of the Pharmacopoeia of the 
United States, is the leaves of Sesamum Orientale or Benne plant ; Sex. 
Syst. Didynamia Angiospermia ; Nat. Ord. Bignonise, Pedaliacese, 
(Lindley,) an annual plant, which is a native of India, but has been 
cultivated in various parts of the world ; and is supposed to have been 
introduced from Africa into the Southern states, as well as into the 
West Indies, by the negroes. 

The seeds afford, on expression, a fixed oil — O'LEUM SES'AMI or Benne 
oil — which is in the secondary list of the Pharmacopoeia of the United 
States. It resembles olive oil in its properties, and is used for the same 
purposes. 

When one or two fresh benne leaves are stirred in about half a pint 
of cool water, a quantity of gummy matter is imparted to the water, 
which soon renders it viscid. When the leaves are dried, they may be 
put into hot water. The mucilage, thus formed, possesses the same 
properties as mucilage of gum arabic; and may be used as a demulcent 
expectorant. 

27. SAS'SAFRAS MEDUL'LA.— SAS'SAFRAS pith. 

The pith of the stems of Laurus sassafras, — whose general proper- 
ties are described under Excitants — is met with in the shops in slender 
cylindrical pieces, which are very light and spongy ; and have a muci- 
laginous taste, with the flavour of sassafras. They contain a large 
quantity of gummy matter, which is imparted to water, so as to form a 
mucilaginous solution : this is used whenever mucilages are required 
internally ; and, therefore, as a demulcent expectorant. The mucilage 
may be made for internal use by adding a drachm of the pith to a pint 
of boiling water ; but it is not often prescribed internally. It is most 
frequently used as a soothing application in ophthalmia. 



252 



SPECIAL EXPECTORANTS. 



28. ULMUS.— SLIP'PERY ELM BARK. 



The inner bark of Ulmusjii.lv a, Slippery elm or Red elm ; Sex. Syst. 
Pentandria Digynia ; Nat. Ord. Amentacese or Ulraacese, abounds in 
mucilaginous matter, which it readily imparts to water. Slippery elm 
is indigenous in this country, flourishing in every part of the United 
States to the north of Carolina, but most so in the Western states. The 
inner bark is found in the shops, freed from the epidermis, in long, 
nearly flat pieces, which may be reduced to powder by grinding. Its 
smell is peculiar, but not agreeable ; and its taste, when chewed, is 
mucilaginous. 

Slippery elm bark is almost always prescribed in the form of tea or 
infusion. A mucilage may, however, be made by stirring the powder 
in hot water. 

MU'SUM TUMI, INFUSION OF SLIPPERY ELM BARK, (tf/miconcis. etcon- 
tus. 3j ; Aquse bullient. Oj.) This may be taken as a demulcent expec- 
torant in catarrhal affections ; but it is not much used. 

29. CETKA'RIA.— ICELAND MOSS. 

Cetraria Islandica } Lichen Islandicus or Iceland moss ; Sex. Syst. 
Cryptogamia ; Nat. Ord. Lichenes, — Lichen- 
Flg ' 57# acese, (Lindley,) is found in the northern lati- 

tudes of both continents, and is said to be 
abundant on the mountains and in the sandy 
plains of New England. It is imported into 
England from Hamburg and Gothenburg, and 
is said to be the produce of Norway and Ice- 
land. In 1839, 15,933 pounds, according to 
Dr. Pereira, paid duty in England. As met 
with in the shops, it is of a brownish or grayish- 
white colour; has little or no odour, and a 
bitter, mucilaginous, somewhat astringent taste. 
The dry plant, steeped in water, absorbs more 
than its own weight of the fluid. When ana- 
cetraria wwdfcl lv 3 ed b y Berzelius, it yielded 44.6 per cent, of 

starchy matter, Lichenin, — 3.0 of a peculiar 
bitter principle, termed Cetrarin, and whose medical properties will be 
considered elsewhere ; 7.3 of gum and uncrystallizable sugar ; 7 of ex- 
tractive matter ; 36.2 of starchy lignin, besides colouring matter, and 
various salts. 

Cetraria may be deprived of its bitter principle by a double macera- 
tion in water, or in water containing ^h part of an alkaline carbonate. 
If it be then dried and reduced to powder, it forms a nutritive aliment, 
which is made into bread by the Icelanders and Laplanders, or boiled 
with milk. 

Cetraria has been much used in cases where demulcents in general 
are indicated ; and, therefore, as a demulcent expectorant. It is em- 
ployed, also, in pulmonary affections like arrow-root, sago, or tapioca, 




CHONDRUS. 



253 



as a bland, nutritious article of diet, and it does not seem to possess any 
advantage over those articles. It has been highly extolled in pulmonary 
consumption ; but is now universally considered to possess no peculiar 
properties either in that or any other disease. The powder is occa- 
sionally — but very rarely— given in the dose of from 3ss to 5j ; and it 
is sometimes mixed with chocolate, and taken night and morning for 
breakfast and supper. The most common form of administration is the 

DECOC'TM CETRA'RIJl, DECOCTION OF ICELAffl) MOSS. (Cetrarix gss ; Aqua 
Oiss. Boil to a pint, and strain forcibly.) The bitter principle or cetrarin 
is contained in this decoction. It thus contains demulcent and tonic 
virtues. The bitterness may, however, be first extracted — as before 
remarked — by maceration in water, or in a weak alkaline ley. The 
quantity to be taken during the day, as a demulcent and nutrient, is 
about a pint in divided doses. It is sometimes mixed with milk. 

30. CHONDRUS.— IRISH MOSS. 

Carrageen, Corigeen or Irish Moss, Chrondrus crispus, Lichen Car- 
rigeen, Fucus crispus, Sphxrococcus crispus, Viva crispa or Chondrus 
polymorphic s ; Sex. Syst. Cryptogamia Algee ; Nat. Ord. Algae— 
Algaceee (Lindley) ; it is found, in the Atlantic ocean, on the shores of 
England, Ireland, western France, Spain and Portugal, and as far as the 
Tropics, and is also said to be a native of the United States. For medicinal 
and dietetic purposes, it is collected on the coast of Ireland (especially 
in Clare), where it is washed, bleached by exposure to the sun, and 
dried. In Ireland, it is used by the poor as an article of diet. 

When Irish moss is green it resembles Iceland moss ; but as met with 
in the shops, it is dry, crisp, and of a yellowish or dirty white hue, re- 
sembling laminse of horn. It is nearly inodorous, and has a mucilagi- 
nous taste. When chewed, it feels like so much cartilage, but by the 
warmth and moisture of the mouth it soon loses its brittleness. Its main 
constituent is a vegetable jelly — which exists in it in the proportion of 
79.1 per cent., and which has been considered to consist of Pectin, in 
large proportion — and starch ; but which Dr. Pereira esteems a peculiar 
principle and calls Carrageenin. It contains likewise, 9.5 per cent, of 
mucus, and traces of salts. 

In order to obtain the jelly of the moss, it is cut small, carefully freed 
from impurities, boiled with water or milk, if the latter should be desir- 
able, and strained. Von Grafe obtained from nine ounces of milk, boiled 
with half a drachm of the moss, five ounces of jelly ; and as much fromy J 
a drachm and a half of the moss, and twelve ounces of water. To the U ^~ 
jelly, thus formed, any dietetic or therapeutical agent may be added. 

Irish moss has been recommended under the same circumstances as 
Iceland moss ; and it would appear, that, like it, no more service can 
be expected from it than from substances that contain a similar principle. 
Accordingly, few prescribe it with any other view than as a demulcent 
and nutritious aliment, where such appears to be indicated. 

To remove any unpleasant flavour, which the moss may have acquired 



254 SPECIAL EXPECTORANTS. 

from impurities, it is advised, that before it is boiled, it should be mace- 
rated in water for a few minutes. 

Chondrus is in the secondary list of the Pharmacopoeia of the United 
States ; Cetraria in the primary ; but there is no sufficient reason per- 
haps to assign the one a more important place than the other. 

31. FUCUS AMYLA'CEUS.— CEYLON MOSS, MARINE MOSS. 

The attention of physicians was first directed to this vegetable by Dr. 
O'Shaughnessy of Calcutta. Like chondrus it belongs to the natural 
order Algee ; and was first introduced some years ago, from India into 
England. As met with in the shops, it is white, filiform and fibrous ; and 
has the usual odour of sea weeds. Analyzed by Dr. O'Shaughnessy, it 
was found to be composed of vegetable jelly, 54.50; true starch, 15; 
wax, a trace ; ligneous fibre, 18 ; gum, 4 ; sulphate of soda and chlo- 
ride of sodium, 6.50; sulphate and phosphate of lime, 1 ; iron, a trace ; 
loss, 1. When boiled in water, a liquid results, which gelatinizes on 
cooling. The jelly is prepared like that of chondrus ; and it possesses 
similar medical properties. It is largely employed by the practitioners of 
India. (See the author's New Remedies, 5th edit. p. 328. Philad. 1846.) 

The Pharmacopoeia of the United States contains in its secondary 
list : 

32. Wola, Vi'olet, — the herb of Viola pedata. — Sex. Syst. Pentan- 
dria Monogynia ; Nat. Ord. Violacea?,-r-an indigenous violet, which 
flowers in May and June. All the violets contain a principle re- 
sembling emetia, which has been called Violine or Violia, and the exist- 
ence of which in small quantities — it has been supposed — may account 
for the expectorant properties ascribed to the plant. The author has 
never known it used. 

III. Nauseant, and Emetic Expectorants. 

Of the mode in which nauseants and emetics probably act as expec- 
torants, a brief notice has been taken already (p. 225). It is evident, 
that all agents which are capable of inducing nausea, followed or not 
by emesis, may be employed as expectorants ; and it is not improbable, 
that if they be given short of inducing nausea, some action of sedation 
may be exerted by them ; and that, therefore, they may be adapted, as 
sedative expectorants, for cases of pulmonary disease in which the or- 
ganic actions are over-excited. This at least may be the case with the 
Tartrate of Antimony and Potassa, Ipecacuanha, Lobelia, &c. ; 
but on the other hand, if certain agents, as Squill, be given in a small 
dose, they act as excitants, and hence it is important, that they should 
be pushed to an extent but little, if at all, short of inducing nausea. 

Of the nauseants, ipecacuanha is most frequently perhaps prescribed 
as an expectorant, singly, or — what is far more common — in combina- 
tion with opium ; and not unfrequently it is added to demulcent mix- 
tures to aid their expectorant agency. The following form introduced 



ACETUM. 255 

into the last edition of the Pharmacopoeia of the United States, (1842,) 
is a combination of this kind. 

Trochis'ci Ipecacuan'h^, Troches of Ipecacuanha. {Ipecac, pulv. 
§ss ; Sacchar. pulv. §xiv. Marant. pulv. §iv ; mucilag. tragacanth. q. s. 
Each troche to weigh ten grains.) These lozenges are well adapted for 
inflammatory affections of the lining membrane of the bronchial tubes. 

IV. Topical Expectorants. — Inhalations. 

a. Excitant Inhalations. 
33. BENZO'INUM.— BEN'ZOIN. 

Of the virtues of this balsam as an excitant expectorant mention has 
already been made (p. 235). At times, it is employed in the way of 
vapour; but caution is demanded in inhaling it, as it excites coughing, 
unless largely diluted with atmospheric air. It ought to be inhaled 
along with the vapour of water, by breaking benzoin into pieces ; putting 
them into a jar, and pouring boiling water over them. In this manner, 
the acid rises with the vapour and is taken into the lungs. Its action is 
excitant to the nerves of the lining membrane of the air passages, and 
through them to the respiratory nerves in general ; and it has seemed to 
have afforded decided relief in asthma depending on some morbid con- 
dition approaching paralysis of the pneumogastric nerves. (Dr. A. T. 
Thomson.) It is said to have proved beneficial even in phthisis after 
the existence of tubercles had been clearly ascertained ; but it can only 
have acted as a palliative, and probably in the manner already described, 
through its excitant impression on the respiratory nerves, expectoration 
being thus facilitated, and dyspnoea relieved. MM. Trousseau and 
Pidoux strongly recommend a mode of employing the balsams in chronic 
laryngitis, which consists in throwing some of the benzoin or the balsam 
of Tolu on hot coals. They advise this plan in preference to inhalations 
of boiling water containing the balsam, inasmuch as the patient can 
remain without fatigue for whole days in a balsamic atmosphere. They 
affirm that chronic catarrh has been removed in this way, which had 
resisted the internal use of the balsams. None of the balsams are much 
used in this manner on this side the Atlantic, or in Great Britain. 

34. ACE'TUM.— VIN'EGAR. 

Vinegar is the result of what is termed the acetous fermentation, and 
is impure dilute acetic acid. All liquids, that are capable of the vinous 
fermentation, are equally so of the acetous, and can, therefore, afford 
vinegar : hence it is made from various substances ; — in France and 
Spain from the lighter wines ; in Great Britain from malt and malt 
liquors, and in the United States from cider. For the use of the white 
lead manufacturer, it is said to have been extensively prepared, of late 
years, from potatoes. (Wood & Bache.) 

The difference in the quality of commercial vinegars is very great, 
some being four times as strong as others. Certain vinegars are, indeed, 



256 SPECIAL EXPECTORANTS. 

so weak, as not to be fit for the preparation of the Acetum Destillatum ; 
and others are so full of impurities, that they can scarcely be used for 
making certain officinal preparations. It was not without reason, there- 
fore, that the framers of the Pharmacopoeia of the United Staies (1842) 
gave the following rules for determining its strength and purity. " One 
fluidounce is saturated by about thirty grains of crystallized bicarbonate 
of potassa. It affords no precipitate with solution of chloride of barium, 
and is not coloured by sulpho-hydric acid." The solution of the chlo- 
ride of barium detects sulphuric acid, if any be present ; and the sulpho- 
hydric acid the presence of metallic matter. 

The French vinegars — as a general rule — are better for all purposes 
than the British. The best qualities imported into Great Britain are 
from Bordeaux, and are known under the name of Champagne Vinegar, 
although made from other wines. Two sorts of wine vinegar are met 
with in commerce, made from wines of a corresponding colour : that 
from the red wines may be decolourized by passing it repeatedly through 
animal charcoal. In this country — as before remarked — vinegar is gene- 
rally made from cider that has become sour. This is put into a barrel 
in a warm place, along with good vinegar, or mother of vinegar, which 
acts as a ferment. The vinegar is ready in the course of a few weeks. 

The constituents of vinegar are essentially acetic acid, and water ; in 
addition to which it contains colouring matter, gum, starch, sugar, &c. 
&c, according to the particular substance from which it has been de- 
rived. 

As a topical expectorant, it is sometimes used, being put hot into the 
ordinary inhaler, and in a dilute state. In this manner, it acts as an ex- 
citant to the bronchial nerves, and is of service in the same cases as 
benzoic acid and other balsams, by facilitating the expectoration of mu- 
cus, and other secretions that may have collected in the air passages. 
It has been of advantage in asthma, and various spasmodic affections 
of the respiratory organs. It has been advised by Dr. A. T. Thomson, 
that distilled vinegar should be employed by preference, as common 
vinegar is apt to contain sulphuric acid. 

35. ACE'TUM DESTILLA'TUM.— DISTIL'LED VIN'EGAR. 

This is made by distilling, from eight pints of vinegar, seven, and 
preserving these for use. One fluidounce of this should be capable of 
being saturated by about thirty-five grains of crystallized bicarbonate of 
potassa. 

Distilled vinegar is colourless, or of a yellowish hue ; and contains, 
besides acetic acid and water, a little alcohol, acetic ether, and a sub- 
stance of a mucilaginous character, which, when the acid is saturated 
by an alkali, causes the solution to be of a reddish or brownish colour. 
When properly prepared, it has no empyreumatic or other disagreeable 
taint. 

A diluted acetic acid, which has the same strength as distilled vine- 
gar, is made by taking the acetic acid— AC'IDM ACETICM of the Phar- 
macopoeia of the United States, (1842,)— which is prepared by the 
action of sulphuric acid on acetate of soda, and diluting it with ten parts 



CHLORINUM. 257 

of distilled water. This is the AC'IDUM ACE'TICM DILU'TUM or diluted 
acetic acid. Either this preparation or the distilled vinegar may be em- 
ployed in the way of inhalation. 

36. TOLUTA'NUM.— TOLU. 

Balsam of Tolu — whose general properties have been already de- 
scribed (p. 232) — may be used as a balsamic fumigation in the same 
cases, and in the same manner as Benzoin. The air of the patient's 
chamber may be impregnated with the vapour, by placing a little of it 
upon live coals, and allowing the vapour to be diffused in the room ; or 
a drachm or two may be put in boiling water, and the vapour be drawn 
into the lungs by means of an ordinary inhaler. 

37. CHLCKRINUM.— CHLORINE. 

Undiluted chlorine gas is irrespirable, occasioning spasmodic closure 
of the glottis, and asphyxia. When largely diluted, it is a power- 
ful irritant to the mucous membrane of the respiratory organs, and 
may develope inflammation in it or in the tissue of the lungs, unless 
great caution is taken in administering it. When largely diluted, it 
may induce a salutary excitant agency ; and has hence been employed 
as a topical expectorant of the excitant class. It has been, indeed, 
affirmed by Dr. A. T. Thomson, that " it is the best topical expectorant 
and the most salutary excitant to the mucous membrane of the lungs 
that has yet been inhaled." 

Chlorine has been administered as a remedy in phthisis ; and many 
testimonials have been brought forward in its favour. It has been ob- 
served, in manufactories in which it is employed, that phthisical patients 
have experienced decided benefit ; but experiments made with it on an 
extensive scale in large public institutions have not confirmed these 
favourable reports ; and some writers of distinction have affirmed, that 
it has been prejudicial. In all cases it has to be employed carefully, and 
experimentally ; but no marked benefit can be expected from it in 
phthisis. It can only be adapted for cases of disease, in which the 
pathological condition of the bronchial mucous membrane, or neigh- 
bouring parts, requires the exhibition of an excitant. In this way, it 
may be occasionally serviceable in chronic bronchitis. 

It may be obtained by putting f.3j or f.Jij of a saturated solution of 
the gas in water — the Aqua Chlorini, (New Remedies, 5th edit. p. 
169, Philad., 1846,) — into an inhaler containing about f.^ij of hot 
water ; and placing this in a basin of hot water, or over a lamp, in or- 
der to drive off the chlorine. The quantity, thus disengaged, may be 
inhaled every six hours. 

It has been proposed to diffuse it, by means of an appropriate appa- 
ratus, in the atmosphere of the sick chamber. For this purpose, any of 
the acids, as the chlorohydric, may be dropped on a mixture of chlori- 
nated lime, so that the chlorine may be disengaged slowly. An appa- 
ratus has been suggested of late years, that answers this purpose well. 
It consists of a light open wire frame,* about 18 inches high ; at the bot- 

Vol. I.— 17 



258 



SPECIAL EXPECTORANTS. 



torn of which is a spirit lamp A. At the proper height above it is an 
evaporating porcelain dish, about six inches in diameter, B ; and above 

this is a glass globe C, with its neck 
Fig. 58.. | downwards. In the neck of the 

globe is a cork D, bored ; and 
through the opening is drawn, mo- 
derately tight, a short plug of cotton 
wick, such* as is used in a spirit 
lamp. In the glass globe at E, op- 
posite the neck, is drilled a ph> 
hole, to allow air to pass in, accord- 
ing as the fluid within drops out 
through the neck. To use it, the 
porcelain dish is filled with hot 
water, the spirit lamp is lighted, 
and as soon as the water in the 
dish has begun to boil, the glass 
globe containing the chloride— if 
this be the substance used — is 
placed as exhibited in the marginal 
figure. The rate at which the fluid 
in the globe shall percolate the cot- 
ton wick, and drop into the hot 
water beneath, is easily regulated, 
inhaler. Should it not drop with sufficient 

rapidity, one or two of the threads 
of the cotton may be removed ; if too rapidly, the cork may be pressed 
in tightly, or one or more additional threads of wick be introduced; 
Eight ounces of a saturated solution of chlorinated lime may be poured 
into the glass globe; and into the water of the porcelain dish two ounces 
of dilute sulphuric acid of the pharmacopoeias. As the solution of the 
chloride drops, the acid seizes on the lime, and chlorine is evolved 
in connexion with aqueous vapour. In this manner, a sufficient supply 
of aqueous vapour is given off to prevent any irritation of the lining 
membrane of the air passages, whilst the invalid experiences neither 
trouble nor fatigue. 




38. IOD'INUM.— I'ODINE. 

The inhalation of iodine has been recommended as an excitant topi- 
cal expectorant in the same diseases as that of chlorine. In phthisical 
affections it has been strongly advised. Sir Charles Scudamore found 
the addition of a little tincture qfconium beneficial in subduing the irrir 
tating qualities of the gas. His first formula was the following solution 
of ioduretted iodide of potassium: — (lodin. gr. viij ; Potass, lodid. 
gr. iij ; Mcohol. f.§ss ; Jiquce destillat. f.^vss. M. Of this solution, from 
l3J to f-3vj, and from twenty to thirty-five minims of a saturated tinc- 
ture of conium were used in each inhalation.) At the temperature of 
90°, the volatile properties of iodine are given off very sensibly, but 
the conium requires more heat, and that of 120° is not too much for the 



VAPOUR OF BOILING TAJl, ETC. 259 

iodine. Sir Charles has since advised the following: — [Iodin. ; Po- 
tass, lodid. aa 3yj '■> Aquce destillat. f.^v & 3vj ; Alcohol, f. 31J. M.) 
He prefers to add the conium at the time of mixing the iodine solution 
with the water, and recommends that it should be a saturated tincture 
of the genuine dried leaves. In the commencement of the treatment, 
he advises very small proportions of the iodine mixture; — for example, 
from f-5ss to f.3j, for an inhalation of eight or ten minutes' duration ; 
and this to be repeated two or three times a day : of the tincture he directs 
f.5ss, — to be increased if the cough be very troublesome. He soon 
augments the quantity of the Iodine mixture from f-3j to f. ^ss ; but the 
feelings of the patient will be a great guide as to the proper strength of 
the inhaling mixture in any particular case. 

The author has often used the iodine inhalation in phthisis, but his 
experience has not been favourable to it ; and the same view has been 
entertained by others. It would seem to be better adapted for cases of 
chronic bronchitis. 

The inhalation may be practised in the method recommended for 
chlorine. At times, troublesome laryngeal irritation has been caused 
by it. Used, however, with the conium, or with aqueous vapour in the 
apparatus recommended by Dr. Corrigan, (p. 258,) this disagreeable 
result may be prevented ; and, in this way, it has been found to dimi- 
nish most remarkably the purulent expectoration of phthisis. It improved 
the tone of the digestive organs ; alleviated the cough, and acted as a 
valuable palliative. Dr. Corrigan has had his apparatus at work from 
eight to twelve hours in the twenty-four ; and his method of managing 
it is as follows : — At night, when the patient is settling to sleep, the 
apparatus is suspended from the roof of the bed, and, when once 
arranged, it continues its work for four or five hours, whilst the patient, 
asleep, is inhaling the medicated air. In the morning, for three or four 
hours before the patient rises, it may be again at work, and, if neces- 
sary, at mid-day, whilst he reclines on the bed, with curtains drawn 
round three of the sides. The rate of evaporation, which has been 
generally found to give a sufficiently strong impregnation to the air, is 
when the tincture of iodine drops from the cotton wick in the globe at 
the rate of six or eight drops per minute. At this rate, about six 
drachms of the tincture will be evaporated in an hour. 

39. VAPOUR OF BOILING TAR, BURNING WOOL, CREASOTE, &c. 

These vapours have been inhaled in cases of phthisis, and in chronic 
laryngitic and bronchitic affections. In the first disease, no great 
benefit can be expected from them. In the latter, they may act as ex- 
citants to the mucous membrane of the air-passages, and, in certain 
cases, be beneficial. 

Tar vapour was strongly recommended in phthisis by Sir Alexander 
Crichton ; but although it has seemed to act occasionally as a palliative, 
it not unfrequently causes a temporary increase of cough and irritation. 
The tar employed should be that used in the cordage of ships ; to every 
pound of which half an ounce of carbonate of potassa is added, in or- 



260 



SPECIAL EXPECTORANTS. 



der to neutralize the pyroligneous acid, which is generally found mixed 
with the tar, and the presence of which may excite coughing. The tar, 
thus prepared, is placed over a lamp in a suitable vessel, and kept 
slowly boiling in the chamber night and day. The vessel ought, how- 
ever, to be cleaned every twenty-four hours ; otherwise the residuum 
may be burned and decomposed, which occasions irritation. 

It is a prevalent idea, that the terebinthinate impregnation of the air, 
which exists in pine regions, is beneficial to the consumptive; and, 
accordingly, patients are frequently sent to spend some time in such 
localities. 

The Vapour of Resin has occasionally been used under similar cir- 
cumstances ; as well as the fumes arising from burning wool that has 
not been dressed. All these vapours are apt to increase the cough at 
first ; but both it and the expectoration would seem to have been ulti- 
mately diminished. They must obviously, however, be uncertain agents 
in all cases, and not easily regulated ; and they cannot, of course, pro- 
duce any material change in the tuberculous condition. 

Creasote, like tar vapour, has been occasionally inhaled in the same 
pulmonary affections : — five, ten or fifteen drops, according to the de- 
gree of tolerance of the lungs, being dropped into hot water, in an 
appropriate vessel ; and the vapour being inhaled through the tube of 
an inverted funnel, or by means of any of the inhalers in use. The re- 
marks on the value of tar vapour in phthisis, and other pulmonary 
affections, apply equally to creasote. 

b. Sedative Inhalations. 
40. STRAMCNIUM. 

Fig. 59. Every part of Datura 

Stramonium, — whose 
general properties are 
described under Nar- 
cotics, — has been 
smoked for the relief 
of asthma, — and whilst 
one part of the plant 
has, in this form, afford- 
ed relief in one case, 
another has been suc- 
cessful in a second. A 
case of this kind has 
been already referred 
to, (p. 227.) In. this 
form of administration, 
a poisonous principle 
is probably developed ; 
for, according to Dr. 
Christison, Mr. Mor- 
ries-Stirling obtained by destructive distillation a poisonous oil, com 




Datura Stramonium. 



ERRHINES. 261 

posed of an inert true oil in union with an active principle, probably a 
modification of Daturia. 

The author has often seen the inhalation of the vapour of stramonium 
highly beneficial. Its modus operandi is probably through the sedative 
influence exerted by the narcotic principle upon the nervous centres to 
which it is conveyed by the blood, as well as upon the ramifications of 
the pneumogastric nerves distributed to the bronchial tubes, — the seda- 
tion being extended to the rest of the nervous system, so that the spas- 
modic affection is subdued. 

Almost all therapeutical writers affirm, that the smoking of stramonium 
is attended with danger where there is a tendency to encephalic disease, 
especially apoplexy ; and where a plethoric state of the system exists ; 
but the author has never witnessed bad effects from it. Of course, 
caution is needed in the use of this powerful narcotic as in that of to- 
bacco; for similar acro-narcotic symptoms may be produced by both. 

4 1 . T AB'ACUM.— TOBACCO. 

When tobacco, — whose general properties have been described 
elsewhere, (p. 135,) — is smoked, not only does the nicotia pass into the 
lungs, but the empyre'umatic oil of tobacco, which is an active poison 
as fopmed in the pipe of the smoker, and appears to be nicotia attached 
to a volatile oil. 

The effect of tobacco, when inhaled, is familiar to most persons, 
for there are probably few males who have not experienced it. It is a 
powerful sedative, making its impression on the nerves of the bronchial 
tubes with which it comes in contact, whence the impression irradiates 
to] every part of the system. In this manner, it is anti-spasmodic. In 
spasmodic asthma, its good effects have been most witnessed ; but it 
does not agree with all, and requires caution, especially in those who 
have not been accustomed to its use. Smoking a cigar is said by Dr. 
Chapman, of Philadelphia, to have been used in a case of croup with 
success. 

The inhalation of Ether and Chloroform is described under another 
head. (See Narcotics.) 



* 
SECTION III. 

AGENTS THAT AFFECT PROMINENTLY THE FOLLICULAR OR GLANDULAR 

ORGANS. 



I. ER'KHINES. 

Synok. Ptarmica, Sternutatoria, Apophlegmatisantia per notes. 

Definition of errhines — Sternutatories — Modus operandi — Dangers of sneezing — Special 

errhines. 

This class of medicinal agents is much less used now than formerly. 
There are, indeed, few cases in which their employment can be sug- 
gested. At one time errhines were separated from sternutatories, — the 



262 ERRHINES. 

former comprising agents, that excite an increased discharge from the 
Schneiderian membrane ; the latter those that provoke sneezing ; but 
the class of errhines is now made to include both under the definition — 
" Agents that occasion an increased discharge from the Schneiderian 
membrane, and sneezing." 

When an irritating substance is placed in contact with the Schneiderian 
membrane, it excites a sensation, through the fifth pair of nerves, or 
nerves of general sensibility, distributed to the* nose, and by a reflex 
action the appropriate muscles concerned in sneezing are thrown into 
contraction, in order that the source of irritation may be ejected by the 
anterior nares. At the same time, if the errhine remains for any time 
in contact with the membrane, a centre of fluxion is established ; the 
follicles augment their secretion; and, if the substance be still more 
irritating, true inflammation is excited. This effect, of course, takes 
place more immediately in the part of the mucous membrane with 
w||jch the errhine comes in contact ; but the excitation is extended more 
or less to the mucous membranes that may be regarded as continuous 
with that which lines the nasal passages, — for example, that which lines 
the sinuses and ductus ad nasum. In this way it can be understood, 
that the operation of an errhine may augment the secretion of tears, and 
occasion more or less suffusion of the eyes ; and, conversely, that an 
inflamed state of the conjunctiva may give rise to increased discharge 
of mucus from the lining membrane of the nasal fossae and sinuses, and 
to sternutation. A sense of irritation in the nose, inciting to the opera- 
tion of clearing the nasal fossae, is a common accompaniment of 
ophthalmia. 

From what has been observed it is clear, that if an errhine be too 
strong, instead of increasing the discharge from the Schneiderian mem- 
brane, it may arrest even the healthy secretion. This is, indeed, one of 
the well known first effects of inflammation of any mucous membrane ; 
and it is not until the inflammation has persisted for some time, that the 
secretions are materially augmented. 

To prevent the induction of inflammatory irritation, the more 
powerful errhines are always weakened by the addition of some inert 
powder. 

Therapeutical Application of Errhines. 

A knowledge of the modus operandi of this class of medicinal agents 
at once suggests the cases, in which they might rationally be had re- 
course to. They occasion a centre of irritation in the part of the mem- 
brane with which they are made to come in contact ; a derivation of 
nervous and vascular action from other parts is thus effected ; an in- 
creased discharge takes place from the exhalants and follicles of the 
nasal mucous membrane — although this has probably but little curative 
agency ; and if they excite sternutation, a strong revulsive impression 
is made. 

Possessed of these properties, errhines have been used in head affec- 
tions in general, and especially in diseases of the eyes and ears; but still, 
their remedial powers are very limited, and if much sneezing be pro- 



ERRHINES. 263 

duced, they may cause more mischief than benefit. It is on this account, 
that they are rarely administered except in popular practice. 

Physiologically, sneezing is set up to clear the nostrils from any 
source of irritation. It is hence often excited in the way of an external 
sensation — that is, by some substance impinging on the Schneiderian 
membrane. But it often occurs, also, as an internal sensation, — that is, 
produced by some organic .change in the mucous membrane itself. 
Hence, it is a symptom of inflammation of the Schneiderian membrane, 
as in common cold, and in the catarrh that attends measles. 

Dr. A. T. Thomson refers to a case of benefit from sternutation in 
which this agency appears to have been prescribed empirically. The 
result may be borne in mind with advantage, as it may attract attention 
to a cause of cephalalgia, that might otherwise be unsuspected. A lady 
was afflicted with violent headache, accompanied by the sensation well 
known by the term stuffing in the head. Many remedies were proposed, 
and tried, but ineffectually. A physician was called in, who prescribed 
snuff as a sternutatory. It produced violent sneezing, and the ejection 
from one of the nostrils of a plug of hardened mucus, nearly an inch 
long ; after which she experienced immediate relief, and, in 24 hours, 
was perfectly recovered. 

From the succussion produced during sneezing, and the compression 
of the abdominal viscera, it has been advised in popular practice, when 
torpor of the uterus exists after the extrusion of the fcetus, with the view 
of exciting that viscus to contraction for the delivery of the secundines ; 
and, at times, it is successful; but an acquaintance with the physiology 
of sneezing will show, that it may occasionally be productive of mis- 
chief, by giving rise to increased flow of blood to the head by the 
arteries, and to impeded return by the veins ; and thus produce apo- 
plexy, epistaxis and other head affections. The succussion, too, 
accompanying it, is evidently improper in pregnancy, and ci fortiori, 
where there is tendency to abortion ; or, where hernia or aneurismal 
disease exists. Conradi esteems errhines to be contra-indicated when 
any inflammatory condition is present ; but this caution is unnecessary, 
as it could scarcely happen, that they would be had recourse to, at least 
before remedies had been employed, which were considered proper for 
the removal of such condition. 

It is probably owing to the apparent violence done to the system, that 
the custom has so long existed, in certain countries more especially, of 
offering a benediction to any one who sneezes. Amongst the Teutonic 
nations, some form of salutation is always bestowed on such occasions. 
Even a professor, whilst addressing his hearers, is compelled to bow 
to the force of custom when any of the class execute this physiological 
act. 

It might be agitated here, whether the habitual use of errhines — as 
of snuff — be prejudicial ; but this is a question, which belongs more to 
hygiene than to therapeutics, and has accordingly been investigated in 
another place. (See the Author's Human Health, p. 334, Philad, 1844.) 



264 SPECIAL ERRHINES. 

> SPECIAL ERRHINES. 

1. VERA'TRUM ALBUM.— WHITE HEL'LEBORE. 

The powdered rhizoma of White Hellebore — whose characters are 
described elsewhere — is possessed of very acrid 'properties when placed 
in contact with a mucous surface, and acts as a powerful errhine ; hence 
the common name of the root — Niesswurzel, " sneezing root," 
in Germany, and of the powder — sneezing powcter, in Great Britain, 
These properties are dependent upon its active principle, ver atria. 

The action of powdered veratrum is so violent, that it requires to be 
diminished by admixture with some mild powder, as starch, wheaten 
flour, or liquorice, — at least three or four parts of these powders being 
required to one of white hellebore powder. Three grains, united with 
nine grains of starch, snuffed up the nostrils for three evenings in suc- 
cession, occasion a copious watery discharge from the nostrils, (A. T. 
Thomson.) In certain chronic encephalic affections, and in amaurosis, 
it has been used with this view, but it is not often prescribed. 

2. VERA'TRIA 

Veratria, — the active principle of veratrum album, — is a powerful 
errhine, the smallest appreciable quantity, applid to the Schneiderian 
membrane, exciting the most violent and repeated sternutation. A 
very minute quantity of the acetate of veratria, placed in the nostrils of 
a dog by M. Magendie, instantly caused violent sneezing, which con- 
tinued for a long time. 

It has been remarked, that we possess the means of making a certain 
errhine, always of the same strength, by combining veratria with a por- 
tion of starch sufficient to cover its acrimony ; yet it is proper to remark, 
that it is an article which is frequently adulterated; and it is in this 
way, that many account for the discordance amongst observers as to 
its virtues. It is, moreover, so violent at times in its operation, and if 
the Schneiderian membrane be abraded, so much inconvenience may 
result from its absorption, that if employed at all as an errhine, it 
ought to be so with the greatest caution. 

3. HYDRAR'GYRI SULPHAS FLAVUS.— YELLOW SUPHATE OF MERCURY. 

The yellow sulphate of mercury, described under Emetics, (p. 122,) 
possesses strong errhine powers, and has the advantage over some others 
of always possessing the same degree of strength. It is so violent, how- 
ever, in its operation, that it requires to be mixed with five or six parts 
of some farinaceous powder, as starch. A quantity of this compound 
powder, which conlains one grain of the yellow sulphate, usually pro- 
duces a discharge from the Schneiderian membrane, which may con- 
tinue for several days. It is said to have been found very useful in 
ophthalmic affections; and as it possesses no narcotic properties, 



TABACUM. 265 

" there can be no doubt," says Dr. A. T. Thomson, « that it is superior 
to every other errhine in affections of the head." 

4. AS'ARUM EUROPIUM.— ASARABAC'CA. 

Asarum of the British Pharmacopoeias is not identical with asarum of 
the Pharmacopoeia of the United States ; the latter being an excitant 
tonic, and, therefore, not falling under consideration here. The Euro- 
pean asarum or common asarabacca ; Sex. Syst. Dodecandria Monogy- 
nia ; Nat. Ord. Aristolochiaceae, is a small herbaceous plant, growing 
in moist hilly woods in England, as well as in many parts of the Euro- 
pean continent. The leaves are officinal in the British Pharmacopoeias. 
They are almost inodorous, but have an acrid, aromatic and bitter 
taste. The root of the shops is about the size of a goose-quill, of a 
grayish colour, quadrangular, knotted and twisted. It has a smell like 
that of pepper, and a nauseous bitter, hot, acrid taste ; much of its 
acrimony being lost, however, by drying. The acrid properties of asa- 
rum would seem to be mainly dependent upon liquid volatile oil, and a 
camphoraceous principle. It contains, moreover, bitter extractive. 

Asarabacca is an emetic ; but is never used as such. It is only em- 
ployed as an errhine, and is said to be the basis of cephalic snuff'. 
When either the powdered leaves or the root are applied to the 
Schneiderian membrane, they excite sneezing, an increased secretion 
of mucus, and may even induce a discharge of blood. The quantity 
used as an errhine is one or two grains of the root, or three or four of 
the leaves, in some cases of obstinate cephalalgia, chronic ophthalmia, 
or tooth-ache. 

The Dublin Pharmacopoeia has a Pulvis asari compositus, composed 
of asarum ^j ; lavender flowers £j ; which is used in the same cases, in 
the quantity of gr. v to gr. viij. , 

5. TAB'ACUM.— tobacco. 

Tobacco, in the form of snuff, is a well known errhine ; not, however, 
habitually employed with that view, but as one form of inducing 
pleasurable excitement through its peculiar impression on the olfactory 
nerves. 

In the manufacture of snufT, the tobacco is cut into small pieces ; is 
first fermented by being placed in heaps, and sprinkled with water or 
a solution of salt — the latter preventing the tobacco from becoming 
mouldy. The heaps soon become hot, and evolve ammonia. The 
extent, to which this process is permitted to go, varies according to the 
kind of snuff, from one month to two or three, — the latter being^the 
usual period. It is then ground in mills, or powdered with a kind of 
pestle and mortar. Some of the snuffs — as the Scotch, Irish, Welsh and 
Spanish— are high dried. Others — as the different varieties of Rappees — 
are moist. 

Of the effects of the abuse of snuff on the system, the author has 
treated in another work, (Human Health, p. 334, Philad. 1844.) In 
this place it has only to be spoken of as a therapeutical agent. To those 



266 SIALOGOGUES. 

who are unaccustomed to its use, it occasions an increased secretion of 
the nasal mucus and sternutation. Where slight and transient effects 
of the kind are needed, snuff may be employed ; but it is a far less 
energetic errhine than others in the list. 



Besides the errhines mentioned, others have been occasionally em- 
ployed. 

6. Euphor'bium. — This is the concrete resinous juice of an undeter- 
mined species of Euphorbia, which is obtained in Morocco, and ex- 
ported from Mogadore. It causes obstinate sneezing, discharge of 
bloody mucus, and great torture, if snuffed up the nostrils ; and, 
therefore, requires to be diluted with some mild, feculaceous powder. 
It is rarely, however, used ; and is not in the lists of the Pharmacopoeia 
of the United States. 

7. The root of Iris Florenti'na, Florentine Orris; Sex. Syst. 
Triandria Monogynia ; Nat. Ord. Iridacese. 8. Rosmarinus, Rose'- 
mary. 9. Lavandula, Lavender ; and 10. Orig'anum Majora'na, 
Sweet Mar'joram ; Sex. Syst. Didynamia Gymnospermia : Nat. Ord. 
Labiatse; have been classed amongst the errhines, and may act as such 
by virtue of the essential oil which they contain ; but they are more 
employed on account of their aromatic properties as adjuncts to err- 
hines of a more powerful character. Dried lavender flowers are a con- 
stituent of Pulvis Asari compositus of the Dublin Pharmacopoeia. 



II. SIAL'OGOGUES. 

Synon. Ptyalogogues, Ptyasmagogues, Salivants, Apophlegmatismi seu Apophlegmatisantia 

per os. 

Definition of sialogogues — Their employment limited — Modus operandi of sialogogues — 
Mercury a sialogogue — Special sialogogues. 

Sialogogues are agents, that increase the salivary discharge. The 
general modus operandi of local sialogogues or masticatories is analogous 
to that of errhines. By their excitant properties, they irritate the lining 
membrane of the mouth ; and the irritation, thus induced, is extended 
along the ducts to the salivary glands ; so that not only is the quantity 
of fluid inhaled from the mucous membranes increased, but salivation 
results. In this way, depletion follows their employment, and more or 
less revulsive effect supervenes, which may act beneficially on parts at 
a distance labouring under disease. Occasionally, also, they may prove 
useful, as in cases of paralysis of the muscles of the tongue, by their 
directly excitant properties. It is obvious, however, that they cannot 
be of benefit except in local palsy of the organ. Where the origin of 
the disease is cerebral, little or no advantage can be expected from them. 

Therapeutical application of Sialogogues. 

The employment of sialogogues must necessarily be extremely limited. 
They are occasionally used as masticatories in toothache and in head 
affections, — precisely, indeed, in the cases that are condsidered to indi- 



PYRETHRUM. 267 

cate the use of substances, which excite irritation in, and increased 
discharge from, the lining membrane of the nasal cavities. 

By some writers on Therapeutics, mercury has been ranked amongst 
sialogogues, and salivation is certainly one of the effects resulting from 
its administration. It is now, however, generally admitted, that this 
result is never necessary, and that it is rather to be deplored, inasmuch 
as the increased discharge exhausts and irritates, without producing 
any benefit whatever. When this potent article of the materia medica 
is duly exhibited, it induces a new action, not only in the salivary 
glands, but in every part of the glandular and follicular, and, perhaps 
of the whole secretory system ; and as this new action is incompatible 
with the one that may be already existing, the latter yields. In this 
point of view, therefore, mercury is a revellent ; and is referred to else- 
where. Ptyalism may likewise be induced by various other agents, — 
as by iodine, the preparations of gold, copper, antimony, arsenic, and 
it is said to have followed the employment of castor oil, digitalis, and 
Opium. Medicines, which act in this manner, have been termed 
specific or remote sialogogues. 



SPECIAL SIALOGOGUES. 

1. PYR'ETHRUM.— PEL'LITORY. 

Anihemis Pyrethrum, Anacyclus Pyrethrum, Pellitory of Spain ; Sex. 
Syst. Syngenesia Polygamia superflua ; Nat. Ord. Compositae, is an 
inhabitant of Arabia and Syria, and of France, Italy, Germany, and other 
parts of Europe. The root is the officinal portion ; but none of it 
appears to have been imported into England from the Levant since 
the year 1836, during which year duty was paid on 420 lbs. (Pereira.) 
It has, indeed, fallen into disuse, and has been placed in the secondary 
list of the Pharmacopoeia of the United States. 

The root, as met with in the shops, is in pieces about the length and 
thickness of the little finger ; of a brown colour externally ; mottled 
with black shining spots ; breaking with a resinous fracture ; and 
having a radiated structure internally. It is inodorous ; and, when 
chewed, occasions a peculiar sense of heat, pungency and tingling in 
the mouth, which continues for some time, and is accompanied by a 
copious flow of saliva. Its properties appear to be dependent upon a 
brown acrid resin, an acrid brown fixed oil, and a yellow acrid oil, 
which have been termed collectively Pyrethrin : as, however, Hagen 
and Schonwald have obtained from it a scentless volatile oil, possessing 
the peculiar taste of the root, it has been thought probable, that this is 
the active principle, and that it adheres forcibly to the resin and fixed 
oil. (Christison.) 

Pellitory root is employed almost exclusively as a sialogogue in 
certain neuralgic affections of the head and face, in palsy of the tongue, 
and of the muscles of deglutition ; and, occasionally, both as a mastica- 
tory, and, in the form of infusion, in relaxation of the uvula and isthmus 



26S 



SPECIAL SIALOGOGUES. 



faucium. It has been much used as a masticatory in toothache, as well 
as in the form of tincture. (Pyrethr. p. i ; Meckel, p. v.) 

2. MEZE'REUM.— MEZE'REON. 

Mezereon bark, whose properties are described elsewhere, owes its 
excitant action to an acrid resin, by virtue of which it is a good masti- 
catory, and has been used as such in cases of toothache ; — a small por- 
tion of the bark being kept constantly in the mouth and the saliva being 
ejected as it is secreted, on account of the injurious effects likely to be 
induced on the digestive mucous membrane, should it be swallowed. 
In a case of dysphagia, induced by paralysis of three years' standing, 
mezereon root was prescribed as a masticatory ; and in less than a 
month the patient recovered the power of deglutition. 

3. CAL'AMUS.— SWEET FLAG. 

The general properties of the rhizoma of Acorus Calamus are de- 
scribed under the head of Excitants. Its medicinal agency is depen- 
dent upon volatile oil. When chewed it produces the ordinary excitant 
effects of the sialogogues in general ; hence it is substituted for tobacco 
by such as are desirous of discontinuing the use of the latter. It need 
scarcely be said, however, that the two agents resemble each other only 
in their operation as local excitants. The calamus is possessed of no 
narcotic properties. It may be used whenever a masticatory is needed. 

4. ARMORA'CIA.— HORSERADISH. 

Fi g- 60 - Horseradish is the fresh root of 

Cochlearia Jlrmoracia ; Sex. Syst. 
Tetradynamia Siliculosa;NAT. Ord. 
CruciferaB or Brassicacese ; — a na- 
tive of western Europe, growing 
wild on the sides of ditches, and 
other moist situations ; and flower- 
ing in June. It is cultivated almost 
every where. 

When scraped, it is a well-known 
condiment ; has a pungent taste ; 
and exhales a highly penetrating 
acrid vapour. These properties 
appear to reside in an exceedingly 
pungent, acrid, diffusible volatile 
oil, which is present in small pro- 
portion ; — according to one expe- 
rimenter (Duncan), cited by Dr. 
Christison, forming not more than 
four parts in a thousand : whilst 
another (Gutret) got scarcely a 
sixth part of that proportion. It is 
difficult, however, to conceive, that 
3b. \ R pS e -5 3 8ufcir ns and pis - so small a quantity of the acrid prin- 




Cochlearia armoracia 
1. Radical leaf 



DIURETICS. 269 

ciple can produce so much excitation. The odour of the oil, obtained 
without water, is extremely powerful, and like that of horseradish. A 
single drop, is sufficient to impregnate the air of a whole room. 

Horseradish has been used as a masticatory in cases of paralysis of 
the tongue. It powerfully excites the nerves of the lining membrane 
of the mouth ; and, through it, the salivary glands, which augment their 
secretion. It is by virtue of its excitant agency, that it is serviceable, 
when made into a syrup, in certain cases of aphonia, dysphonia, or 
hoarseness, where the affection is dependent upon want of power in 
the nerves concerned in phonation, or upon a state of the intrinsic 
organs of voice, which excitants are capable of benefiting. 

5. ZIN'GIBER.— GINGER. 

The rhizoma of Zingiber officinale — which is described elsewhere — 
when chewed, occasions an increased flow of saliva. It has been used 
as a masticatory in paralysis of the tongue and of the muscles of deglu- 
tition. 

6. TAB'ACUM.— TOBACCO. 

Tobacco is a well-known masticatory and sialogogue ; but it differs 
from the other articles of the class in possessing peculiar properties, by 
which it acts, when swallowed, on the nervous system, and — as has been 
seen elsewhere — powerfully depresses the powers of the organism. 
When used, therefore, simply as a sialogogue, the saliva ought not to 
be swallowed. Indeed, there are few persons, who have been in the 
habit of chewing tobacco largely, that can swallow any portion of the 
juice with impunity. 

It is sometimes chewed to relieve toothache, and a portion of the relief 
obtained is, doubtless, owing to the action of the narcotic principle. It 
is not, however, an agent which is easy of management in those who 
are accustomed to it ; and they who are in the habit of chewing it, 
receive but little if any benefit from it. It is properly considered to be 
contra-indicated in paralysis of the tongue, and of the organs of deglu- 
tition. The simply excitant masticatories are to be preferred. 



III. DITJRET'ICS. 

Synon. Uretics. 

Definition of diuretics— Their modus operandi — Mental diuretics — Therapeutical employ- 
ment of diuretics — In dropsies — In various chronic diseases — Special diuretics. 

Diuretics are agents that increase the urinary discharge. 

Direct diuretics are such as act immediately and specially on the kid- 
ney, so as to increase its secretion ; and to these the term is more parti- 
cularly appropriated. As in other cases, however, it has been extended, 
so as to include any agency, that may indirectly produce diuresis. 
Thus, diluents may become diuretics, by increasing the mass of the 



270 DIURETICS. 

circulating fluid, and of consequence, the quantity of urine ; — in other 
words, by occasioning the elimination of that, which has been artificially 
introduced ; and, in the same manner, a cool temperature, by diminish- 
ing the amount of the cutaneous and pulmonary depurations, may 
augment that which is effected by the urinary organs. If, too, an in- 
flammatory condition of the kidneys exists, blood-letting, although it 
diminishes the amount of circulating fluid, may restore the diminished 
renal secretion ; — but it is unnecessary to go into the consideration of 
the various agencies that may prove indirectly diuretic : they will sug- 
gest themselves readily to the pathological inquirer. The object, at 
present, is to investigate the modus operandi, and applicability, of sub- 
stances, that belong strictly to the class of diuretics ; — and which, if 
injected into the blood in appropriate doses, seek out the urinary 
organs, and exert on them their operation. The expression " in appro- 
priate doses," is proper, because many of them, as cantharides, and 
turpentine, if given in too great quantity, may induce nephritis, and 
haematuria, without in any manner augmenting the urinary depuration. 

Under ordinary circumstances, it is necessary that a certain quantity 
of urea, or its elements should be separated from the blood ; otherwise, 
disease and death may ensue. Accordingly, whenever the urinary 
secretion is suppressed, in protracted or acute diseases, it is an unfa- 
vourable, and, in many cases, a fatal symptom ; inasmuch as it exhibits 
a total revolution in the accomplishment of indispensable functions, and 
one not likely to admit of restoration. There are, however, anomalous 
cases on record, in which the urinary depuration has not taken place for 
years together ; and, in the "Philosophical Transactions," for 1713, 
Dr. Richardson gives the case of a youth — seventeen years of age — 
who had never passed urine, and yet suffered no inconvenience. Where 
this has resulted from malformation, — as in the last case, — it may be 
conceived that the function might be supplied through some other chan- 
nel, — knowing, as we do, the surprising instances of a similar kind met 
with in certain cases of monstrosity ; but it is not so easy to comprehend 
those cases, in which the depuration, — after having been established for 
a length of time, — has been entirely arrested, and with apparent impunity. 

Allusion has already been made to the compensation that appears 
to exist between the two great depurations — urinary and cutaneous. 
This compensation is such, that if the one be diminished from any cause, 
the other is proportionably increased ; and it is probable, that when the 
urinary depuration is diminished, some of the principles may pass off 
by perspiration, as urea has been detected in the fluid of the cutaneous 
exhalation. Perhaps, too, in those diseases, in which we are in the 
habit, and with propriety, of regarding suppression of the urinary secre- 
tion as a fatal symptom, the mischief arises less from the retention of 
matters that ought to be evacuated, than from the deranged state of the 
system — the complete bouleversement of functions — which- the suppres- 
sion announces. 

Of the different substances, ranked under the head of diuretics, some 
pass into the mass of blood, and proceed to the kidneys, without expe- 
riencing any decomposition ; others, on the contrary, undergo changes 
in the first passages, and it is the result only of such changes, that 



MODUS OPERANDI. 271 

i 

excites diuresis. To the first class belong potassa, dilute mineral acids, 
nitrate of potassa, the oils of turpentine, juniper, &c. The feaster on 
garlic and asparagus is reminded, by the odour of his urine, of the 
kind of vegetable that has ministered to his repast ; but these are more 
properly examples of the separation of the odorous principles in the first 
passages. 

Reference has already been made to the opinion, — that, when acetic 
acid is united to potassa, as in the acetate of potassa, a separation of the 
constituents takes place in the stomach, the potassa being set free, and 
the acetic acid digested, — and it was remarked on that occasion, that as 
the chlorohydric acid exists in a state of health, in the gastric secretions, 
should any such separation take place, the potassa would be laid hold 
of by this acid, and chloride of potassium be formed, which would enter 
the circulation unchanged. The same may be said of the potassa, and 
its alkaline fellows, when united to other vegetable acids. Our know- 
ledge, however, on this point of animal chemistry, is not very precise, 
and many of our ideas are probably inaccurate. This seems to be the 
case in respect to the bitartrate of potassa, on which Dr. A. T. Thomson 
has the following remarks, when speaking of it as a diuretic. " Its 
effects in this respect are explained by Dr. Paris on the probability of 
the decomposition of the salt in transitu ; and, consequently, the con- 
veyance of the alkaline base to the kidneys. It is possible, that this ex- 
planation maybe correct; but when we consider that the quantity of 
alkali contained in the dose of the bitartrate is equal only to five grains, 
when a scruple of the bitartrate is taken, and that seven grains of the 
alkali are taken when twenty minims of the liquor potassse are adminis- 
tered, yet that the effects of the bitartrate are much more considerable 
in producing diuresis than the liquor potassae, there is some difficulty in 
assenting to the accuracy of this explanation." 

The comments previously made regarding the salts formed by a com- 
bination of a vegetable acid with an alkaline base, apply to this salt ; 
and, if any decomposition be effected, it must probably be, in part, 
through the agency of the mineral acid, which is always contained in 
the gastric juice. In the mode and quantity, however, in which the 
bitartrate of potassa is usually taken as a diuretic, — that is, in solution, 
in the way of common drink — a portion probably escapes any kind of 
decomposition, and passes into the blood unchanged. In the state of 
solution, it is eminently adapted for ready absorption, and therefore is 
enabled to pass through the coats of the blood-vessels of the stomach 
and duodenum, by imbibition. — in the way in which tenuous fluids in 
general readily enter the circulation. 

Of the diuretics, which are set free in the stomach, or, in other words, 
are separated there from the substances with which they are combined, 
we have marked examples in the vegetable substances, whose diuretic 
properties are dependent upon oil or oleo-resin ; — as the different tur- 
pentines, copaiba, cubebs, juniper berries, &c. Even where essential 
oil is combined with resin it is not certain, that the resin is not separated 
from the oil by the digestive process, whilst the latter only is taken into 
the circulation, and proceeds to the kidney, to excite its appropriate 
stimulation. In the case, indeed, of every vegetable, a separation must 



272 DIURETICS. 

take place in the stomach between the diuretic and the rest of its com- 
ponents; and the same applies to the only animal diuretic in the lists — 
cantharis or blistering fly, — the active principle of which — cantharidin 
— is separated during the digestive process ; and probably alone enters 
the circulation, and proceeds to the urinary organs. 

Lastly, certain mental emotions may be regarded as diuretics ; these 
are of the same character as the mental cathartics. Fear and anxiety 
of mind are well known agents. Dr. Thomson remarks, that various 
sounds, and even odours, operate, in the same manner through the 
medium of the nerves ; and he refers to Shakspeare, who ascribes this 
effect to the sound of the bagpipe — 

" And others, when the bagpipe sings i' the nose, 
Cannot contain their urine." 

But these are cases, which exhibit the influence of sensations and emo- 
tions on the power of retention rather than on that of secretion. The 
like result, too, is produced by the exciting emotions. Excessive joy 
has given rise to the same incontinence as excessive dread ; a fact well 
elucidated by Cervantes, in the effect which he describes to have been 
produced on Sancho's daughter, when the joyful tidings were communi- 
cated to her, that her father had been made governor of Barataria ! 

By occasioning a copious discharge of the more fluid portions of the 
blood, diuretics are, to a certain extent, evacuants ; but they are rarely 
employed as such, unless for the purpose of occasioning greater activity 
of absorption, as in cases where an undue exhalation or accumulation 
of fluid has taken place in one or more of the serous cavities. In other 
words, diuretics are not often prescribed as depletives, where antiphlo- 
gistics are indicated. Their effect is too trivial to make any decided 
impression. 

It is perhaps by their revulsive action, combined with diuresis, that 
they are beneficial in certain diseases. The diuresis itself is a sufficient 
evidence of their operation as local excitants, even were we not aware, 
that nephritis, or hematuria, or both, frequently result from their ad- 
ministration in too large a dose, — a fact, which it is important to bear 
in mind in affections of the kidney, accompanied by inflammation, and 
diminished urinary secretion, in which, from an attention to the latter 
circumstance only, their employment might seem to be clearly indicated. 
In such affections, they could not fail to add to the mischief, and the 
best diuretics would obviously be — the lancet and the antiphlogistic 
medication, which, by removing the pathological cause of the diminished 
secretion, would give indirect occasion to its restoration. 

Therapeutical •Application of Diuretics. 

Febrile and inflammatory affections. — From what has been said of 
the properties of diuretics, their therapeutical employment will be intel- 
ligible. Much benefit cannot, of course, be expected from them in 
febrile affections, or in internal inflammations of parts at a distance from 
the urinary organs ; and it would obviously be improper to administer 



MODUS OPERANDI. 273 

any but simple diluents where the kidney is suffering under inflammatory 
irritation. It has been already remarked, that as simple evacuants not 
much reliance can be placed upon them : we have other depletives in- 
finitely more effective in such cases. 

Dropsies. — The chief diseases in which diuretics are prescribed are 
those of a dropsical character ; especially of the abdomen or areolar 
membrane. By augmenting the secretion from the kidneys, the quantity 
of circulating fluid is necessarily diminished; imbibition is augmented ; 
the fluid of the dropsy soaks through the parietes of the blood-vessels ; 
and, in this way, such collections may be made to disappear. It is 
probable, too, that an essential part of the effect is dependent upon the 
revulsive operation of the diuretic. Acting as a local excitant to the 
kidney, it occasions an afflux of vital energy to the organ ; and thus 
diminishes the too great exhalation from the vessels of the serous mem- 
brane. Reliance is, however, rarely placed upon the administration of 
diuretics alone in dropsy. The precise pathological condition, which 
gives rise to it, has to be attentively investigated ; and an appropriate 
system of medication to be united with the diuretic. Thus, the dropsy 
is often manifestly of an active or sthenic character, so that blood-letting 
or cathartics, or both, are indicated; and these being premised, more 
benefit may accrue from the diuresis than would otherwise have resulted. 
Frequently, in such cases, a combination of agents of another character 
with diuretics may be prescribed with advantage. Mercury is an exci- 
tant of the secretory system ; squill is a diuretic ; their conjoint action 
will, therefore, be as follows : — the mercury produces an action of re- 
vulsion, — a distraction of vital manifestation from the seat of the dropsi- 
cal affection to the parts on which it exerts its local stimulation ; the 
exhalation from the serous membrane is consequently reduced even 
below the healthy point; a similar influence is exerted by the local 
stimulation of the diuretic, whilst, in addition, under its operation the 
absorbed fluid is discharged. Hence, a combination of mercury with 
digitalis, squill, or some other diuretic, is one of the most useful and 
most common prescriptions in dropsical cases. 

It is obvious, that diuretics can never be productive of essential 
benefit, where organic mischief exists in any of the viscera. Impeded 
circulation in the viscera gives occasion to the worst forms of dropsy, as 
the visceral mischief does not usually admit of remedy. Of this nature 
is the organic disease of the kidney, to which attention was originally 
directed by Dr. Bright, in the first volume of his " Reports" and which 
is distinguished by the coagulable state of the urine, — albuminuria. This 
is often accompanied by dropsy, although not always. In such cases, 
the author has been very cautious in the administration of excitant 
diuretics ; under the apprehension, that they might add to the irritation 
already present in the kidneys. It is proper, however, to observe, thai 
they have not been regarded by some as contra-indicated in these very 
cases. Dr. Christison thinks, that a stimulus of one kind may be em- 
ployed with impunity, and even with advantage, when an organ is 
labouring under irritation of a different kind ; and he affirms that diu- 
retics do not augment the quantity of albumen in the urine, the amount 
of which has been generally regarded as an index of the degree of local 

Vol. I.— 18. 



274 SPECIAL DIURETICS. 

irritation. He considers the best combination, in such dropsical cases, 
to be, — digitalis, a sedative diuretic, with bitartrate of potassa, an ex- 
1 citant diuretic ; the efficacy of the diuretic in such cases being increased 

^ by the use of an emetic or brisk cathartic. 

Rheumatic affections. — Diuretics have been frequently recommended 
in various chronic diseases, especially of a rheumatic nature. In lum- 
bago and sciatica, the oils of the different terebinthinates, as well as the 
terebinthinates themselves, have been much used ; and, at times, with 
marked advantage ; but their modus operandi is probably altogether 
revellent, — not owing to the diuresis they occasion. 

On the whole, therefore, the class of diuretics, although often had re- 
course to by the practitioner, cannot be considered to comprise our 
most efficacious agents in the management of disease. They are appli- 
cable to but few morbid conditions, and many of these can be as well 
treated by other remedies. Accordingly, they are by no means as often 
employed at the present day as they were formerly. 



SPECIAL DIURETICS. 

These may be divided into two classes. 1. Excitant Diuretics, and 
2. Sedative Diuretics; the former clearly acting as excitants to the 
kidneys, and not, therefore, w T ell adapted when there is any inflamma- 
tory condition of those organs ; the latter acting more, perhaps, upon 
the organic actions generally ; diminishing the power of the heart and 
arteries ; and therefore well adapted for sthenic dropsies. These sub- 
stances seem to act but slightly on the kidneys as true diuretics, and the 
objection has been made to ranking digitalis amongst diuretics, — that its 
action seems to consist in removing the cause of the dropsy, the fluid 
being then carried off' in the usual manner ; so that it is no more a 
diuretic than is quinia in dropsies caused by intermittents. — (Wohler 
cited by J. Muller.) It is probable, however, that not only digitalis, but 
the other agents classed as sedative diuretics are capable of acting 
directly upon the kidneys so as to increase the secretion from them. 

I. Excitant Diuretics. 

1. JUNIP'ERUS.— JU'NIPER. 

The excitant properties of juniper are described elsewhere. These 
are shown to be dependent upon its volatile oil — O'LEUI JUNIP'ERI. The 
diuretic virtue is dependent upon the same ; and, according to some 
experiments, in the dose of four drops, which may be given in sugar, 
it is one of the most certain of diuretics. Dr. Christison states, that he 
has found five minims of the oil, mixed with a fluidrachm of spirit of 
nitric ether, given three times a day in any common vehicle, produce 
diuresis in dropsy, when other means had failed. The berries when 
eaten, affect the urinary organs, increasing the secretion from the kid- 



scoparius. 275 

neys ; and, in large doses, producing renal and vesical irritation. The 
urine acquires a violet odour under their use. They are occasionally 
given as a diuretic in dropsy, but are rarely trusted to alone. They may 
be rubbed up with sugar, and taken in the dose of a drachm or two, 
three or four times a day. This, however, is not the form in which they 
are usually prescribed. The author is constantly in the habit of directing 
them to be taken in infusion as common drink. This may be made by 
pouring on an ounce of the berries a pint of boiling water, letting it 
stand till cold, and taking the whole pint in the course of the twenty- 
four hours. Where the diuretic agency of bitartrate of potassa seems to 
be indicated, two drachms of it may be added to the juniper berries 
prior to infusing them. 

SPMTUS MIP'ERI C0MP0S1TUS, COMPOUND SPIRIT OF JU'NIPER. {Juniper. 
contus. $j ; Carui contus. ; Fceniculi contus. aa 3iss ; •Alcohol, 
dilut. cong. ; Jlqua Oij.) 

This spirit, when sweetened, has been regarded as a substitute for 
Hollands, and for common gin, both of which contain oil of juniper ; 
and hence gin toddy, or hot gin and water, is occasionally prescribed to 
hydropics as a diuretic. The combination of carraway and fennel seeds 
adapts it more for an excitant and carminative ; but still, on account of 
the juniper berries, it is most commonly used as an adjunct to diuretic 
mixtures. It is rarely given alone. Its dose is f.3ii to f.^iv ; and both 
it and the spirituous liquors named above may be of service in highly 
asthenic cases of dropsy. 

2. SCOPA'RIUS .— BROOM. 

The fresh tops of Cytisus Scoparius, Spartium Scoparium, common 
broom; Sex. Syst. Diadelphia Decandria ; Nat. Ord. Leguminosae, 
are in the secondary list of the Pharmacopoeia of the United States, into 
which they have been admitted on account of their diuretic properties. 

Broom, — a shrub from three to six feet high, flowering in June, — is 
indigenous in Europe, and cultivated in this country as an ornament to 
the gardens. The tops have a bitter, nauseous taste ; and, when 
bruised in their fresh state, a strong peculiar odour. The seeds possess 
similar properties, and their virtues are yielded to both water and 
alcohol. 

Although broom has been placed in the secondary list of the Phar- 
macopoeia of the United States, and is but little prescribed by the phy- 
sicians in this country, it is highly extolled, and placed in the first 
rank of diuretics by some practitioners. Dr. Pereira, for example, 
affirms, that having very frequently employed it in dropsies, he can add 
his testimony to its powerful effects as a diuretic, and that he cannot 
call to mind a single case in which it has failed to act on the kidneys. 
In some cases, it produced a most marked and beneficial influence on 
the dropsical effusion, and, in his opinion, it is more certain than any 
other diuretic in dropsies. Owing to its bitter principle, it is at the 
same time tonic ; and, consequently, adapted for cases in which the 
union of a tonic and a diuretic is needed, as in the asthenic forms of 



276 SPECIAL DIURETICS. 

dropsy. When given in too large a dose, it acts both as a cathartic 
and an emetic. 

The London Pharmacopoeia has an Infusum Scoparii, (Scopar. §j ; 
Jlquce bullient. Oj ;) the dose of which, as a diuretic, is f.5j. to f.^ij ; — 
a Decoctum Scoparii Compositum, {Scoparii ; Juniper. ; Taraxac. aa 
§ss ; Jlquce Oiss. Boil down to a pint. Dose f.^j. to f.^ij :) which is 
a combination of diuretics ; and the Dublin Pharmacopoeia a watery ex- 
tract prepared from a decoction of the tops — Extractum Spartii Sco- 
parii — the dose of which is from 3ss. to 3j ; but it is rarely pre- 
scribed. 

3. SCILLA— SQUILL. 

Squill — which has been described under Emetics (p. 130) — has long 
had the reputation of an active diuretic. As such it has been frequently 
prescribed in dropsical cases; and, at the present day, is perhaps em- 
ployed as often as any remedy belonging to the class. It is rarely, 
however, given alone, being combined either with other diuretics — as 
digitalis, bitrartrate of potassa, or juniper berries, — or with a revellent, 
as the mild chloride of mercury. It is an excitant diuretic, and there- 
fore less adapted than digitalis for cases in which there is much vascular 
excitement, especially of the kidneys. Its dose, in substance, is one 
grain, repeated every four or five hours. At times, its diuretic influence 
is not exhibited until it has been pushed so as to induce nausea. 

The dose of the ACE'TUl SCILUE, (p. 131), as a diuretic is f.rss to 
f.$j ; and of the TEVCTU'RA SCILLE, (p. 131), from i^x. to t^xx. 

4. CHIMAPH'ILA.— PIPSIS'SEWA. 

The leaves of Chimaphila umbellata, Ch. corymbosa, Pyrola umbel- 
lata, Pipsissewa, umbellated winter-green ; Sex. Syst. Decandria Mo- 
nogynia ; Nat. Ord. Pyrolacese, are officinal in the Pharmacopoeia of 
the United States ; and the whole herb in those of Edinburgh and 
Dublin. It is a beautiful evergreen ; and is indigenous in the northern 
parts of Europe, Asia, and America, flowering in June and July. 

Chimaphila has a bitter sweetish taste, with some degree of astrin- 
gency. Boiling water and alcohol extract their virtues. When subjected 
to analysis, they yield bitter extractive, resin, tannic acid, gum, lignin 
and saline matters. It is not determined in what principle the main 
activity resides ; but, it has been presumed, in the bitter extractive. 
The constituents would show, that the leaves must be tonic, by reason 
of the bitter principle ; and astringent by reason of the tannic acid. 
They have, likewise, a decided effect in increasing the secretion of the 
kidneys-; and the same marvellous virtues have been assigned to them 
as to diosma crenata and uva ursi, in diseases of the urinary organs in 
general ! It is in dropsy, however, that the diuretic action of chima- 
phila has been most frequently servicealjle ; and it may be beneficially 
employed wherever a tonico-diuretic is indicated. The author has 
often used it in atonic dropsy, and with decided advantage. An exten- 
sive series of experiments was made at the BUrger hospital at Pesth in 



CAINC-E RADIX. 



277 



regard to its remedial powers in dropsy. Within two years, nearly 200 
cases are said to have been radically cured by it. It is generally given 
in decoction ; but a watery extract is sometimes prepared from it, which 
may be prescribed in the dose of 20 or 30 grains, three or four times a 
day. 



Fig. 61. 




Chimaphila umbellata. - 

DECOC'TUM CHIMAPH'ILl, DECOCTION OF PIPSIS'SEWA. {Chimaphil. cont. 
§j ; Aqux Oiss. Boil to a pint.) The whole of this may be taken in 
24 hours. Where it is desirable to act, at the same time, on the bowels, 
senna leaves may be added. 



5. CAIN'c^E RADIX.— CAINCA ROOT. 



Radix Cdinca, R. Chiococcce, R. Cdinanae, R.Caninanse, R. Cahincce, 
R. Kahincas, R. Serpentarice Braziliensis, Ca'inca Root, is not in the 
British or American Pharmacopoeias. It is the root of Chiococca angui- 



278 SPECIAL DIURETICS. 

Juga ; Sex. Syst. Pentandria Monogynia ; Nat. Ord. Rubiaceae ; a 
shrub, which grows wild in Brazil, where the root is employed against 
the bites of serpents. It is of the thickness of the finger, round and 
knotty ; the surface is irregularly wrinkled ; the wood tough, and of a 
whitish colour; the smell, especially of the fresh root, disagreeable; 
and the taste at first like that of coffee, but afterwards nauseous and 
pungent. The bark of the root is alone actjve ; — the woody portion 
being inert : its virtues are extracted by water and alcohol. Chemical 
analysis has shown one of its constituents to be a bitter principle, crys- 
tallizable in small, white, shining silky needles, which has an acid 
reaction, owing to the existence of a peculiar acid — the Cahincic acid — 
and in which the medical virtues appear to reside. It was found by 
MM. Pelletier and Caventou to contain, likewise, a fatty, green, nau- 
seous odorous substance, which gives the plant its smell ; and a yellow, 
and, also, a viscid colouring matter. 

The main therapeutical effect of Cainca is exerted on the digestive 
and urinary organs. It occasions watery evacuations, and increased 
secretion of urine. It has been doubted, however, whether its benefi- 
cial effects in dropsical cases have not been dependent rather upon its 
cathartic than its diuretic agency. The testimony in regard to its action 
in dropsy has been discordant, but many have deposed very strongly in 
its favour. It is given in various forms of preparation — powder, infu- 
sion, decoction, tincture, extract, syrup and wine. The wine is formed 
from one ounce of the powdered root to a pint of wine; the tincture 
from one part of the root to eight parts of alcohol. The dose of the 
powder is from 9j to 3ss in the 24 hours. It appears, however, that it 
gives rise to disagreeable symptoms more frequently than the other 
forms. 

It is affirmed, that there is a remarkable analogy between cai'nca and 
apocynum cannabinum. 

6. BAL'LOTA LANA'TA. 

Ballota Lanata, Sex. Syst. Didynamia Gymnospermia ; Nat. Ord. 
Labiatae, is a plant which grows exclusively and commonly in Siberia, 
where it has long had great reputation in dropsy. It has been, of late 
years, introduced into Russia, Germany and Italy, but has not been 
employed in this country. The whole plant is used, except the root; 
and ample testimony exists to show, that it largely increases the urinary 
secretion, and has produced unequivocally good effects in dropsical 
cases. The form of preparation usually prescribed is the decoction. 
{Ballot. Lanat. §iss — §ij ; Aquce Oij ; boil to a pint. Dose, a cupful, 
night and morning.) 

7. SPIR'ITUS ^E'THERIS NI'TRICI.— SPIRIT OF NITRIC ETHER. 

Spirit of Nitric Ether, Spiritus Nitri dulcis, Sweet Spirit of Nitre, 
Mtre Drops, or — as it is often called— Nitre, is a mixture of impure 
hyponitrous ether and alcohol. According to the process of the Edin- 
burgh Pharmacopoeia, it is formed by first preparing nitric or hypo- 



potassjE bitartras. 279 

nitrous ether, and then diluting this with alcohol. The Pharmacopoeia of 
the United States does not generate the ether by the direct mutual re- 
action of nitric acid and alcohol ; but provides the materials for the 
formation of the nitric acid, as in the annexed process : — Take of Ni- 
trate of potassa, in coarse powder, fgij ; Sulphuric acid, fgiss ; Alcohol, 
nine pints and a half; Diluted alcohol, a pint ; Carbonate of potassa, 3j ; 
Mix the nitrate of potassa and the alcohol in a large glass retort, and, 
having gradually poured in the acid, digest with a gentle heat for two 
hours ; then raise the heat and distil a gallon. To the distilled liquor 
add the diluted alcohol and carbonate of potassa, and again distil a 
gallon. 

The redistillation from carbonate of potassa is directed to get rid of 
some acid, which is always contained in the product of the first distil- 
lation. Spirit of nitric etherj thus obtained, has the specific gravity 
0.834; is colourless; has a peculiar and fragrant ethereal odour and a 
pungent, slightly sweet and acidulous taste. It reddens litmus paper, 
but does not effervesce with carbonate of soda ; by keeping, however, 
it becomes decidedly acid, and may decompose various substances with 
which it is frequently combined in prescriptions. To obviate this, it 
may be kept on crystals of carbonate of potassa. It is very volatile, 
and therefore requires to be preserved in well stopped bottles. It dis- 
solves in water and alcohol in all proportions. It is very extensively 
adulterated, sometimes with three or four times its weight of alcohol 
and water. Dr. Pereira states, that in July 1840, Mr. Hennell, of 
Apothecaries' Hall, London, informed him, that it was then selling in 
the trade at a price, which was but just above that of the duty on the 
spirit used in manufacturing the genuine article. "Wholesale dealers, 
too, are said to keep two or even three qualities of the preparation. 
The density and flavour will lead to a tolerably accurate estimate of its 
goodness. 

Spirit of nitric ether decidedly increases the action of the kidneys ; 
yet it is rarely given alone in dropsical cases ; and not very often in 
association. It may be combined with squill, bitartrate of potassa, 
juniper berries, &c. It must be borne in mind, however, that it is an 
excitant diuretic ; and ought, therefore, to be given with caution in 
dropsies connected with disease of the kidney. It is best adapted for 
those of the asthenic kind. Its dose, as a diuretic, is from f.^ss to f.3ij 
in water, repeated tw T o or three times a day. 

SALTS OF POTASSA. 
8. POTAS'S^E BITAR'TRAS.— BITARTRATE OF POTAS'SA. 

Bitartrate of potassa, in small doses, is a diuretic, and as such is used 
in dropsical cases, — rarely alone, sometimes combined w r ith other diu- 
retics, as squill, digitalis, juniper berries, &c. ; at others, united with 
cathartics, to which class of medicinal agents it likewise belongs. (See 
page 194.) 

As a diuretic, it may be given in molasses, in the dose of a scruple 
to a drachm, repeated two or three times in the twenty-four hours. This 



280 SPECIAL DIURETICS. 

is not, however, so good a form as a solution of the salt made by pour- 
ing a quart of boiling water on half an ounce of the bitartrate, sweeten- 
ing with sugar, and flavouring or not with lemon-peel. This may be 
taken freely as common drink unless it should act too much upon the 
intestines. The ordinary imperial is made by dissolving a drachm, or 
a drachm and a half, of the bitartrate in a pint of boiling water, and 
adding lemon-peel and sugar. A cream of tartar whey is made by add- 
ing .about two drachms of the bitartrate to a pint of milk, which may be 
diluted with water, and drunk as a diuretic in hydropic affections. The 
salt may also be rendered soluble by borax or boracic acid,, and be 
given in this way. 

9. POTAS'S^: NITRAS.— NITRATE OF POTAS'SA. 

Nitrate of Potassa, Nitre or Saltpetre, occurs in both the inorganic 
and the organized kingdom. In the former, it is met with in certain 
soils, efflorescing on the surface ; in the latter, it has been found in va- 
rious plants. For the modes in which it is obtained from its natural 
sources, as well as artificially, the reader is referred to chemical works. 
It is found naturally in various parts of the United States, especially in 
the southern and western portions, where it occurs, for the most part, in 
caverns or limestock rock, called salpetre caves, and is associated with 
nitrate of lime. The earths, contained in these caves, are lixiviated ; 
and yield, according to the impregnation, from one to ten pounds of 
crude nitre to the bushel. These caves are especially numerous in Ken- 
tucky, and are said to have furnished a large portion of the nitre used 
in the United States during the last war. (Wood & Bache.) The 
greater part of the nitrate of potassa used now in England and in this 
country, is obtained in various parts of the East Indies by a similar kind 
of lixiviation. 

Crude saltpetre, as met with in commerce, requires to be purified for 
medicinal purposes. This is done by dissolving it in two parts of hot 
water ; filtering the liquor and setting it aside, so that, on cooling, crys- 
tals may form. 

Nitrate of potassa is also prepared, in many parts of Europe, from 
soils artificially impregnated with animal matter, or from the mortar of 
old buildings, especially of the under-ground floor; or from artificial 
composts, consisting of animal substances, decaying vegetables, ashes 
and chalk, marl or lime. The nitrate, thus produced in the first place, 
is the nitrate of lime, which is converted into nitrate of potassa by the 
addition of carbonate of potassa. 

As met with in the shops, nitrate of potassa is tolerably pure. It is 
in fragments of crystals, of considerable size, which are striated, opaque, 
colourless, six-sided prisms, terminated by one, two, or six converging 
planes. The crystals are unalterable in the air, and wholly soluble 
in water. They have a sharp, cooling taste. The salt is occasionally 
adulterated with sulphate of potassa, and chloride of potassium. The 
sulphate is detected by a solution of the chloride of barium, which oc- 
casions a white precipitate of sulphate of baryta ; the chloride, by the 
nitrate of silver, which produces a white precipitate of chloride of 
silver. 



CANTHARIS. 



281 



Besides its other properties, nitrate of potassa possesses those of a 
diuretic. It is taken up into the mass of blood, and is separated by 
the kidneys, so that it may be detected in the urine. It is not often, 
however, prescribed as a diuretic, in consequence of there being more 
potent articles of the class. It may be given in the dose of gr. x. to 
3ss. dissolved in water ; and its action may be facilitated by taking 
diluents freely. 

10. POTAS'SiE ACE'TAS.— ACETATE OF POTAS'SA. 

Acetate of potassa, which was formerly termed Sal diureticus, had at 
one time great reputation for its powers in augmenting the urinary se- 
cretion ; but it is not now much employed. In large doses — as else- 
where shown, (p. 196,) — it is cathartic ; and may produce a joint 
cathartic and diuretic action. It was highly thought of by Dr. Dun- 
can, jr., in dropsy ; and M. Alibert considered it the best of diuretics in 
hydrothorox. It unquestionably is diuretic in small doses ; and may, 
therefore, be serviceable in dropsies ; but it is less efficacious, appa- 
rently, than bitartrate of potassa, which has now usurped its place. 

An acetate may be made by saturating vinegar with the potassa of 
the carbonate of potasssa. 

Acetate of potassa — as before remarked — must undergo decomposi- 
tion in the stomach, if chlorohydric acid be present; and it is affirmed, 
that if none should exist there, the potassa alone enters the circula- 
tion, and is separated by the kidney. If this explanation be true, the 
diuretic agency must be ascribed to the potassa, and not to the ace- 
tate. The dose, as a diuretic, is from gr. x. to gr. xx., given in any 
diluent or demulcent. 

11. SALTS OF SODA. 

Many of the salts of soda are diuretic, but none of them eminently 
so. The Borate — Sod;e Boras — has been sometimes given in dropsy, 
in the dose of 3ss to 3j, frequently repeated ; the Carbonate" — Sod.*: 
Carbonas — in the dose of gr. x. to 3 SS "> an( l the Bicarbonate — Sod^: 
Bicarbonas — in the dose of gr. x. to 3j ; but they are never trusted to 
alone, and it is doubtful whether they are worthy of being classed 
amongst the active diuretics. 

12. CAN'THARIS.— SPANISH FLIES. 

The Spanish Fly or Blister Beetle — Class, Insecta; Order, Co- 

leoptera, is a native of the 
Fi g- 62 * south of Europe, and also of 

Germany and Russia ; and it 
has been met with in Eng- 
land. In the summer of 
1837, according to Dr. Pe- 
reira, it was abundant in Es- 
sex, and Suffolk. It is found 
on species of Oleaceae, as 
the ash, privet, and lilac ; 
and of Caprifoliacese — as the 
elder and lonicera. It inhabits the earth in the larve state ; and ap- 




Cantharides. 



282 SPECIAL DIURETICS. 

pears in the form of fly in May, when it infests the trees and shrubs in 
such numbers, in some of the promenades of southern Europe, as to 
drive away the visiters. The flies are caught either in the morning or 
evening, at which time they are less active, by spreading cloths under 
the trees, which are strongly shaken or beaten with long poles. The 
collectors are obliged to have both their faces and hands protected. 
After they have fallen off they are killed by being exposed to the va- 
pour of vinegar, hot water, spirit of wine, or oil of turpentine ; or by 
immersing the cloths containing them in hot vinegar and water, and 
then drying them. At one time, Spain supplied cantharides largely, 
whence their name Spanish Flies ; but at the present day, they are im- 
ported partly from Messina, and partly from St. Petersburg. They are 
very abundant in the southern provinces of Russia. The Russian flies 
are the largest and most esteemed. In the year 1839, duty was paid in 
England on 16,376 pounds. (Pereira.) 

Dried Spanish Flies — as met with in the shops — are from six to ten 
lines long, and about a grain and a half in weight. Their odour is 
peculiar and disagreeable ; their taste acrid and burning. They should 
be kept perfectly dry by means of well stopped bottles, and as they are 
subject to destruction by insects — which devour the vesicating portion 
with the rest — it may be well to sprinkle them with pyroligneous acid, 
or with a few drops of strong acetic acid. This last has been found an 
excellent preservative. When dried, they can be reduced to a powder, 
which has a grayish-brown appearance, with numberless shining green 
particles. It is in this condition that they are most liable to adultera- 
tion. When in the entire state, their goodness is appreciated by their 
odour, and freedom from mites and other insects. The powder is some- 
times adulterated with powdered euphorbium, especially in the forma- 
tion of the plaster ; and Dr. Pereira affirms, that he has been informed 
by persons well acquainted with the fact, that it is a common practice, 
amongst»certain druggists, to mix one pound of euphorbium with four- 
teen pounds of powdered Spanish Flies. 

Cantharides have often been analyzed, but the results obtained by 
M. Robiquet have received the most attention. He found them to contain, 
1. A peculiar principle — cantharidin — procured by concentrating an 
alcoholic tincture obtained by displacement; and setting it aside, so that 
the cantharidin may crystallize : the blistering property of cantharides 
is evident in this. 2. A green fatty oil, soluble in alcohol. 3. A fatty 
matter insoluble in alcohol. 4. A yellow viscid substance, analogous 
to osmazome. 5. A black colouring matter. 6. A yellow colouring 
matter. 7. Free acetic and uric acids ; and 8. Phosphate of lime, and 
phosphate of magnesia. The main active constituent appears to be the 
cantharidin, and it would seem to exist only in the trunk and soft parts 
of the body, as the other parts have been found inert or nearly so ; yet 
there would appear to be some volatile odorous matter exhaled from the 
insects, as irritation is produced by sitting under trees on which they 
are found, or by breathing the vapour from a decoction of them. The 
virtues of cantharides are yielded to boiling water ; but more readily 
to acetic acid ; alcohol, pure and dilute ;— ether, and the fixed and vo- 
latile oils. Of their effects when applied to the cutaneous surface, men- 



CANTHARIS VITTATA. 283 

tion will be made in another place. Taken internally, they are a violent 
acrid poison ; and have therefore to be prescribed with great caution as 
a medicinal agent. When given in too large a dose, their effects on 
the genito-urinary system are exhibited by the ordinary signs of nephri- 
tis and cystitis. By the extension of the irritation through contiguous 
sympathy, priapism, and sometimes satyriasis are induced in the male ; 
and irritation of the sexual organs, and occasionally abortion in the fe- 
male. When given to this extent, the renal secretion may be diminished 
or arrested. In a smaller dose, however, they excite the kidneys to 
increased action ; but although always classed amongst diuretics, they 
are uncertain in their operation, and are really more beneficial as revel- 
lents, through the nephritic irritation which they induce c accordingly, 
they are less prescribed in diseases, which, like dropsy, require an aug- 
mentation of the secretory action of the kidneys, than in neuralgic 
affections, which, like lumbago and sciatica, are best relieved by revel- 
lents. It can likewise be understood, that, by virtue of those same'ex- 
citant properties, they may be beneficial in paralysis of the bladder, 
and in cases of atony of the genito-urinary organs in general. Should 
cystitis be induced by them, it must be met by blood-letting, and by the 
free use of demulcent drinks. 

The dose of the powdered flies is one or two grains, which may be 
made into a pill with conserve of roses, or extract of taraxacum, which 
may be repeated twice a day. The tincture, however, is more fre- 
quently employed. 

TINCTU'RA CANTHARTDIS, TINCTURE OP SPANISH FLIES, ( Cantharid. contus. 
^j ; Alcohol, dilut. Oij. Prepared by simple maceration, or by dis- 
placement.) The dose is n\x to f.^j, repeated three or four times a day 
in some demulcent fluid, as barley water or flaxseed tea. 

The external application of cantharides will fall under consideration 
elsewhere. 



13. CAN'THARIS VITTA'TA.— POTA'TO FLY. 

Cantharis Vittata, Lytta Vittata, Potato Fly, is somewhat smaller 
than Cantharis Ve$icatoria,—\{s length being about six lines. The 
head is of a light red colour, with dark spots on the top ; the feelers 
are black ; the elytra or wing-cases black, with a yellow, longitudinal 
stripe in the centre, and a yellow margin ; the thorax is black, with 
three yellow lines ; and the abdomen and legs, which are of the same 
colour, are covered with an ash-coloured down. (Wood & Bache.) 
The flies appear—as their name imports — on the potato plant, and are 
first observed about the end of July or the beginning of August. 
They are found in the morning and evening; and are collected by 
shaking them from the plant into hot water; after which they are 
carefully dried in the sun. 

Cantharis vittata is a native of the middle and southern States. It 
resembles cantharis vesicatoria in all its properties. 

Other species of cantharis are found in the United States, viz. C. 



284 



SPECIAL DIURETICS. 



Cinerea, a native of the northern and middle States ; C. Marginata ; 
C. Atrata, common in the northern and middle States, &c. &c. ; but 
C. Vittata is the only one that is officinal. 



14. TARAX'ACUM.— DAN'DELION. 



Fig. 63. 



ntodon Taraxacum, Taraxacum Dens Leonis, Common Dandelion; 
£ eo Sex. Syst. Syngene- 

sia Polygamia iEqua- 
lis : Nat. Ord. Com- 
positae Cichoracese ; is 
indigenous in mea- 
dows and pastures in 
most parts of the 
globe ; flowering all 
the summer. The 
root is the only part 
which is officinal in 
the Pharmacopoeia of 
the United States. 
When fresh, it is ta- 




Leontodon Taraxacum. 



penng, 
with a 



and abounds 
milky juice, 



which contains bitter extractive, caoutchouc, resin, gum, sugar, and 
various salts. It yields its virtues to hot water, and hence the decoc- 
tion is officinal in the Edinburgh and Dublin Pharmacopoeias: the 
extract is in all of the British Pharmacopoeias as well as in that of the 
United States. 

Taraxacum is generally regarded as a diuretic and tonic ; nay, it has 
even been supposed to be in addition, " aperient, deobstruent [?] and 
alterative," but how it produces these effects, and in what cases, we 
have yet to learn. The author has often administered it, and the results 
of all his trials induce him to consider, that its remedial agency is ex- 
tremely restricted. That it is possessed of tonic powers to some extent 
can no more be doubted of it than of other bitter vegetables ; but even 
in this respect it is far inferior to most of the vegetable tonics. " After 
having been long abandoned in practice," observes Dr. Christison — 
" it was resumed not many years ago in this country, (Great Britain,) 
and became a fashionable remedy, especially in London, as a tonic 
aperient and alterative in dyspepsia, and as a deobstruent, and pro- 
moter of the biliary secretion in functional as well as organic diseases 
of the liver. It seems not without its use in dyspepsia and functional 
biliary derangements ; but my own observation of its effects would lead 
me to infer, that much has been ascribed to the extract of dandelion in 
these and other affections, which must have been owing to collateral 
remedies, or to regimen and diet." 

It is asserted to have been found beneficial in cases of dropsy depen- 
dent upon hepatic obstruction ; but it is probable, that farther expe- 
rience will limit more and more the range of its employment, and that 
it may ultimately be discarded altogether. It may be given in the 



COPAIBA. 285 

form of Decoctum Taraxaci, Decoction of Dandelion. (Taraxac. 
contus. §ij ; Jiquoz Oij ; boil to a pint.) Of this, from one to two fluid 
ounces may be given three or four times a day. It may be associated 
with other diuretics, as squill, or bitartrate of potassa. 

EXTRAC'TUM TARAX'ACI, EXTRACT OF DANDELION. This extract is made 
from a decoction of the fresh root. The dose is twenty or thirty grains 
two or three times a day. The author rarely prescribes it except as an 
excipient for certain tonic diuretic or other agents that require to be 
made into pills. 

A Cream of Taraxacum has been proposed by Dr. Collier, which 
he prepares in the following manner. Cut the fresh roots of dande- 
lion, — freed from any adherent earthy matter, and previously washed 
and scraped, — into transverse slices. Sprinkle any quantity of these, 
whilst moist, slightly with spirit of juniper, and express them in a 
tincture press. The dose of the cream, thus expressed, is a table- 
spoonful, or more, twice or thrice a day, which, according to Dr. Col- 
lier, will probably produce two. or more bilious evacuations in the day. 
It may be diluted, and given in the form of draught, with any of the 
diuretic waters and infusions, or with a solution of cream of tartar. J 

15. O'LEUM TEREBINTH'INtE— OIL OF TUR'PENTINE. 

The characters of this volatile oil are pointed out under Excitants. 
In a moderate dose, it is unquestionably an excitant diuretic ; yet its 
properties in this respect are by no means marked, and much of its 
character may have been derived from the fact, that its use — as well as 
that of the terebinthinates in general — gives occasion to a violet odour 
of the urine. It has been administered, however, in dropsy, and in 
asthenic cases is said to have been occasionally serviceable. It cer- 
tainly cannot be indicated in dropsy of the active kind accompanied 
with vascular excitement. In larger doses — as elsewhere remarked — 
it is a powerful excitant of the abdominal nervous system especially, 
and hence has been given in cases of tubercular meningitis, or what 
has been conceived to be the stage of invasion of acute hydrocephalus ; 
but in such case its diuretic operation was not looked to. In cases of 
lumbago, sciatica, &c, its operation is rather revellent than diuretic ; — 
the excitant or revellent action being exerted on the kidneys. It may 
be given in the dose of 8 or 10 drops three times a day, dropped on 
sugar, mixed with molasses, or made into an emulsion with mucilage 
or yolk of egg. 

16. Copa'iba, and 17. Cubebs (see Excitants) act much in the same 
manner as oil of turpentine. They are never given in dropsy as diu- 
retics ; but are prescribed to exert a revellent or excitant action on the 
kidneys. Yet, they are often classed amongst diuretics. 

Besides the agents already prescribed, the Pharmacopoeia of the 
United States has admitted into the secondary list the following ex- 
citant diuretics. N 



286 SPECIAL DIURETICS. 

Caro'ta, Carrotseed — the fruit of Daucus Carota; Sex. Syst. Pen- 
tandria Digynia ; Nat. Ord. Umbelliferse — a common plant, growing 
wild in the United States, and flowering in June and July. The pro- 
perties of carrotseed are probably dependent upon volatile oil, and are 
readily communicated to boiling water. 

Carrotseed are not much used by the physician ; but are frequently 
prescribed as a domestic remedy in affections of the urinary organs, and 
in dropsy. The dose of the bruised seed is from Jss to 3j. They are 
more commonly given in infusion. (Carot. ^j ; Aquas bullient. Oj. to 
be taken during the day.) 

19. Delphin'ium, Larkspur, — the root of Delphinium Consolida ; 
Sex. Syst. Polyandria Trigynia ; Nat. Ord. Ranunculacese — a species 
introduced from Europe, and now naturalized ; flowering in June and 
July. The flowers, seeds and root are all said to be diuretic ; but the 
last is the only part that is officinal. It is little if at all used. 

20. Erig"eron Canaden'se, Canada Fleabane; Sex. Syst. Syn- 
genesia Superflua ; Nat. Ord. Composita? Corymbiferae — an indigenous 
plant, common in the northern and middle States ; flowering in July and 
August. The whole plant is officinal. Its main constituents are tan- 
nic and gallic acids, bitter extractive, and volatile oil. It is, therefore, 
astringent, tonic and, it is affirmed, diuretic; and has been given in 
dropsy and also in chronic diarrhoea and dysentery; either in powder, 
the dose of which is £ss to 5j ; or in infusion. (Eriger. Canadens. ^i; 
Aquae, bullient. Oj. Dose f.5iss to f.^iij-) 

21 & 22. Erig"eron Heterophyl/lum, Various-leaved Fleabane, 
and E. Philadei/phicum, Philadelphia Fleabane ; both of which are 
caTled Scabious — are found in various parts of the United States, and 
are used as diuretics in dropsy. They are given in infusion or decoc- 
tion. (Eriger. jg ; Aquae bullient. Oj. Dose f.5ij to f-iiv, every three 
or four hours.) 

23. Petroseli'num, Parsley — the root of Apium Petroselinum ; Sex. 
Syst. Pentandria Digynia. Nat. Ord. Umbelliferae— a native of southern 
Europe, but cultivated in gardens every where. It contains an essential 
oil, which is said to communicate to it diuretic virtues. It is also affirmed 
to be aperient. The strong infusion has been advised in dropsical affec- 
tions, and in diseases of the urinary organs in which a diuretic is con- 
sidered to be indicated ; but it is hardly ever used, and is not much 
worth the attention of the practitioner.- 

-V" 

II. Sedative Diuretics. 

24. DIGITA'LIS.— FOXGLOVE. 

Digitalis purpurea, Purple Foxglove ; Sex. Syst. Didynamia Angio- 
spermia ; Nat. Ord. Scrophulariaceae, is an herbaceous biennial plant, 



DIGITALIS. 



287 




Digitalis purpurea. 



growing wild in most of the temperate countries of Europe, where it 
begins to flower in June, and ripens 
its seed in August and September. 
In the United States, it is cultivated 
both for ornament, and medicinal 
purposes. The leaves are alone offi- 
cinal in the Pharmacopoeia of the 
United States. The London Phar- 
macopoeia admits, also, the seeds. 

Doubts have existed in the 
minds of many observers in regard 
to the equal activity of the culti- 
vated and the wild specimens ; 
and, in the doubt, the wild or 
native plants have been generally 
preferred. 

The leaves are usually gathered, 
as first advised by Dr. Withering, in 
June or July, when the plant is 
coming into flower, or soon after- 
wards. It has been considered, 
however, unnecessary to restrict 
the gathering of them to this period, 
as their bitterness, which may per- 
haps be some measure of their 
activity, is very intense both in February and September; and their 
extract is highly energetic as a poison in the middle of April, before 
any appearance of the flowering stem. They should be dried very 
carefully, and be preserved from light and air. The midrib and foot- 
stalk — being possessed of little or no efficacy — may be removed before 
drying. In this state, they arfe of a dull green colour, faint odour, 
and a bitter nauseous taste. 

As met with in the shops of this country, digitalis is often in com- 
pressed masses, like the dried herbs in general prepared by the Shakers 
of .Lebanon ; and these cakes are not unfrequently found, to be more or 
less mouldy ; hence this mode of preparation has been properly ob- 
jected to. (Wood and Bache.) It readily yields its virtues to water 
and alcohol. It has been repeatedly analyzed, but no important phar- 
macological information has been obtained. At one time, its active 
principle was supposed to have been discovered, and was termed JDigi- 
talin ; but the discovery was not confirmed, — the digitalin being 
esteemed a mixture of other matters. More recently, however, MM. 
Homolle and Quevenne have succeeded in separating it. When pure, it 
presents itself in the form of a white, inodorous powder, of an excessively 
bitter taste, which is especially experienced in the fauces. When dis- 
seminated in very small particles in the air it causes violent sneezing. 
It is scarcely soluble in cold water ; rather more so in boiling water ; 
and is soluble in all proportions in dilute and concentrated alcohol. 
Pure ether only dissolves traces of it ; but the slightest addition of alco- 
hol considerably increases its solvent power. 



288 SPECIAL DIURETICS. 

An empyreumatic oil has been obtained from the product of destruc- 
tive distillation, which is composed, in part, of a highly narcotic crys- 
talline principle. When given to a rabbit, it caused paralysis of the 
hind legs, convulsions, laborious and rapid breathing, and accelerated 
action of the heart. 

The effects of digitalis on the nervous system, and, through it, on 
many of the functions, will be described under the head of Narcotics. 
In this place, its action on the kidneys alone fells under consideration. 
This it exerts both in disease and health, and hence it is properly a di- 
rect diuretic. 

On inspecting the testimony of various observers in regard to the 
dropsical cases, in which the diuretic virtues of digitalis have seemed 
to exhibit themselves, much that appears to be irrational is perceptible. 
It is well known to be a powerful sedative, and as such is employed 
whenever the force of the circulation has to be controlled, as in hyper- 
trophy of the heart, and in great vascular excitement, no matter how 
produced ; hence it would seem to be especially adapted for the sthenic 
forms of dropsy'; yet we are told by Dr. Withering — and the remark has 
been handed down from one therapeutical writer to another — that " it 
seldom succeeds in men of great natural strength, of tense fibre, of 
warm skin, of florid complexion, or in those with a tight and cordy 
pulse." " On the contrary, if the pulse be feeble or intermitting, the 
countenance pale, the lips livid, the skin cold, the swollen belly soft and 
fluctuating, or the anasarcous limbs readily pitting under the pressure 
of the finger, we may expect the diuretic effects to follow in a kindly 
manner." Yet, if we know anything concerning the modus operandi 
itwiu of digitalis, it ought to be adapted for the first set of cases rather than 
for the latter. Doubtless, it may be itself insufficient to reduce the 
sthenic condition of the system, and may require the use of an active 
antiphlogistic treatment, premised or combined with it ; yet in the sthe- 
nic class of cases, its utility has been* most manifested. Such is the 
result of the author's experience. It certainly has not been found by 
him, as by Dr. Christison, " most serviceable in dropsies associated 
with an enfeebled state of the constitution." The writer just cited 
affirms, moreover, that u dropsies depending on diseased heart, are 
more under its influence than any other kind ; and next those connected 
with diseased kidneys ;" but this cannot be regarded as established. 
No general assertion of the kind is, indeed, admissible, inasmuch as 
every thing will depend upon the degree of cardiac mischief, that 
gives occasion to the dropsy. Too often, in such cases, all remedies 
fail ; and, in the very nature of the circumstances, they can only act as 
palliatives. 

As a diuretic, digitalis should be given in small doses — for example, 
one grain of the powder three times a day, until the effect is induced. 
In all cases, however, the patient should be watched ; and if great de- 
pression of the powers of the circulation, giddiness, insomnia, nausea 
and vomiting, or convulsions should supervene, its use ought to be sus- 
pended. It has been the opinion of some practitioners, that its effects 
are cumulative, and that they may explode— as it were — some time after 
it has been discontinued. This may be borne in mind. At the same 



DIGITALIS. 289 

time, it is proper to add, that although the author has prescribed it 
largely in hospital and in private practice, he has never witnessed this 
cumulation, which has been the source of so much alarm to others. It 
would seem, however, from the results of experiments on digitalin 
by MM. Bouchardat and Sandras, that its toxical power has to be 
feared, notwithstanding the prescriber may have felt secure for several 
days. 

Digitalis is not often, perhaps, given alone as a diuretic. It is either 
combined with squill, bitartrate of potassa, or with the mild chloride of 
mercury — with the latter, for the reasons already expressed, (p. 273 ) 
The Edinburgh College has a Pilula Digitalis et Scill^, which is a 
combination of two of the diuretics mentioned : (Digital., Scillce aa 
p. i : Confect. aromat. p. ii. Beaten into a proper mass with confec- 
tion of red roses, and the mass divided into four-grain pills.) 

The Infusion and the Tincture are officinal in the Pharmacopoeia 
of the United States ; and the latter is perhaps more frequently em- 
ployed. 

INFU'SUM DIGITA'LIS, INFUSION OF FOXGLOVE. (Digitalis 31 ; Aquce bullierd. 
Oss; Tinct. cinnam. f.Sj.) The tincture of cinnamon is added to pre- 
vent the digitalis from affecting the stomach. The infusion is a good 
preparation ; by some, indeed, it is believed to be the most effective 
of any. Its dose is f.^ss to f.^j, repeated every six hours or oftener. 
Observations by Dr. Munk on a very large number of cases induce him 
to give the preference to the infusion as a diuretic over every other pre- 
paration of the drug. 

TINCTU'RA DIGITALIS, TINCTURE OF FOXGLOVE. (Digitalis |iv ; Alcohol, 
dilut. Oij ; — made by maceration, or by displacement.) The usual dose 
of this tincture is ten drops, repeated three times a day, and cautiously 
increased where considered advisable. This quantify the author has 
generally found sufficient to induce not only the diuretic but the sedative 
effects of the drug. Others, however, fix the usual dose at ten minims 
repeated every six hours ; and Dr. Pereira states, that he commonly 
begins with ^xx. The largest dose he has employed is f.^j. It has, 
he states, been given to the extent of one ounce! The author has 
known some cases of protracted and severe disease in which very large 
doses have been administered with impunity ; but these cases of resist- 
ance must be considered as exceptions rather than as forming the rule. 
They may, also, be occasionally explained by inactivity in the prepara- 
tion. None but well-prepared and well-preserved leaves should be 
used in the formation of the tincture ; and a great superiority has been 
noticed in that made from carefully preserved leaves imported from 
England. (Wood & Bache). 

The Germans have a Tinctura Digitalis .ZEtherea, made by mace- 
rating digitalis in sulphuric ether in place of dilute alcohol. Sir George 
Lefevre says, " that this is a very useful preparation, and a convenient 
mode of administering the remedy. The nauseating properties of the 
digitalis, he thinks, are counteracted by the stimulant power of the men- 
struum," and in cases of serous effusion, where it is desirable to 

Vol. I.— 19 



290 SPECIAL DIURETICS. 

increase the action of the absorbents, and to determine to the kidneys, 
this preparation seems to combine those advantages without producing 
the nausea and exhaustion, that frequently accompany the use of the 
simple tincture. 

Digitalin, described above, when exhibited in a very serious case of 
anasarca complicated with pericarditis and hsematuria, caused, accord- 
ing to M. Bouchardat, an enormous and immoderate diuresis, accom- 
panied by greatly diminished frequency of pulse, which, in 48 hours, 
fell from 120 to 54 in the minute. The absorption of the dropsical 
fluid was effected very rapidly, and the treatment proved successful. 
In two cases of pleurisy, the diuretic action was evident, and the ab- 
sorption of the effusion seemed to be hastened. The dose and mode of 
administering this energetic agent require the greatest circumspection. 
MM. Homolle and Quevenne, from comparative essays, have found, 
that four milligrammes (gr. .0616) of digitalin correspond in energy of 
action to about eight French grains (gr. 6.56) of digitalis. 

25. COL'CHICI RADIX.— COL'CHICUM ROOT ; AND COL'CHICI SEMEN. 
COL'CHICUM SEED. 

The general properties of Colchicum are described under the head of 
Sedatives. In it effects it is said, by some, to resemble digitalis in one 
thing, — that it renders the pulse less frequent. Others, however, think, 
that it agrees more with squill in certain respects, and they would, con- 
sequently, class it rather amongst Excitant Diuretics. The root, an4 
the seed have been given as diuretics in dropsy, both formerly and in 
more modern times. In such cases it is well to push the remedy until 
it affects the bowels as well as the kidneys. The dose of the dried root 
and of the seeds is the same, — from two to eight grains. 

ACE'TUM COL'CHICI, M'EGAR OF COL'CHICM- (Colchic. rad. contus. |ij; 
Meet, destillat. Oij ; Alcohol, f.^j ; prepared either by maceration or dis- 
placement.) Vinegar of colchicum has been a favourite diuretic in 
dropsy. Its dose is from f.Jss to f.jj. 

The other preparations of colchicum are given under Sedatives. 

26. VERA'TRIA. 

This active principle, whose properties are described under Seda- 
tives, is also possessed of diuretic powers ; partly, perhaps, as sug- 
gested by Dr. Turnbull, owing to the sedative agency, which it has 
been found to exert on the heart's action, even when applied externally. 
The testimony of one observer in its favour is so strong as to savour of 
undue enthusiasm: — "Unadulterated veratria," says Ebers, " acts often 
on the urinary secretion with magical powers, and it may seem fabu- 
lous, when I state, that friction with a very weak ointment of veratria 
two or three times in the twenty-four hours on the inner part of the 
thigh, or the back, epigastric region or around the naval, has excited 
such a copious secretion of urine, that the patients, under its long con- 
tinuance, began to feel weak, and the anasarca, and even the dropsical 



ANTILITHICS. 291 

accumulation in the abdomen, in a short time almost disappeared ; — 
circumstances, which indicate the caution that ought to be observed in 
apportioning the dose, when we are satisfied of the goodness of the ar- 
ticle." The experience of Ebers has been confirmed by that of others ; 
but some, as Messrs. Bardsley and Spath, have found it of no avail as 
a diuretic, and it is now scarcely employed. 

Veratria may be given in Tincture, (Veratr. gr. iv ; Alcohol. 3}. 
Dose, gtt. x. to xxv. in water) ; or rubbed on the skin in Ointment, 
{Veratr. gr. v. — xx. ; Adipis 3j. A piece, the size of a hazelnut, to 
be rubbed on the skin for five or ten minutes, night and morning.) 




IV. ANTILITH'ICS. 

Definition of antilithics, and of lithonthryptics — Calculous diathesis— Lithic and phospha- 
tic diatheses— Different varieties of calculus — Therapeutical application of antilithics to 
those varieties — Lithonthryptics — Special antilithics. 

The class of antilithics comprises agents, that counteract the tendency 
to the formation of calculous concretions in the urinary organs. Under 
the same head may be investigated the modus operandi of lithonthryp- 
tics or agents which are capable of dissolving such concretions ; but as 
our means for the latter purpose are extremely limited and rarely 
available or successful, attention will be mainly directed to the class of 
antilithics. 

1. Antilithics. 

Antilithics are amongst the most interesting of the classes of thera- 
peutical agents ; for what disorder is there, that excites more mental 
uneasiness and apprehension than any form of calculous deposition ? The 
pain attendant upon the presence of stone in the bladder ; the inutility 
of remedial agents, when once it has formed, excepting so far as con- 
cerns the prevention of its increase, and the serious operations demanded 
for its removal, — are sufficient grounds for the anxiety which is felt by 
every one, when he has reason to believe that he is labouring under a 
calculous diathesis. 

That such a diathesis may be present, we have the most unquestiona- 
ble evidence, and when it exists the greatest difficulty occurs in remov- 
ing the tendency to deposition. Often, it appears to be owing to an 
organization derived from progenitors; when — like every other here- 
ditary tendency — it is almost irremediable, although due attention to 
diet and regimen may accomplish much. 

The diathesis is manifestly connected with a morbid condition of the 
secerning function of the kidney. We find the organ forming that 
which it ought not, and the urine depositing that which it ought not ; 
but this vice of secretion is clearly connected with a morbid condition 
in other organs. The whole system of nutrition is often implicated ; 
the gastric functions are imperfectly performed ; the nutrition of the body 



292 ANTILITHICS. 

is impaired ; and in the phosphatic diathesis especially— when largely 
developed — every symptom is present, which is considered to indicate 
1 1 cachexia . " N ^ j^ 

The ordinary urinary calculi arise from the deposition of substances, 
which are contained in that fluid in a state of health, but are rendered 
insoluble, owing to various circumstances. Some calculi — as the oxa- 
lates — do not exist in the urine in health, and must, consequently, be 
formed by chemico-vital influence in the kidney. It becomes, however, 
an interesting topic of inquiry — whether the mischief in these cases is 
seated altogether in the kidney, or whether it may not be, in part, owing 
to the blood being modified in consequence of general faulty nutrition, 
so that it contains matters that do not exist in it in the normal state. 

In reply to this, it has been urged, that such matters ought to be de- 
tected by the chemical analyst; but the objection is invalid, for the 
reasons elsewhere stated, — that it is by no means easy to detect even 
an inorganic substance, of whose presence we may, notwithstanding, be 
certain, when mixed with compounds of organization : it may be so 
masked by the latter, that its presence cannot be indicated by the ordi- 
nary — or, indeed, by any — re-agents. On the other hand, there is strong 
reason for presuming, that the disease is not altogether seated in the 
kidney, when we reflect on the great similarity between the calculous 
and the gouty diathesis. It is a common remark, founded on just ob- 
servation, that of the children of gouty parents some may be liable to 
gout, and others to calculus, — the males, who are exposed to indulgence 
in the ordinary exciting causes, being more subject to the former 
disease ; — the females to the latter. Both of these cachectic diseases are 
accompanied by more or less gastric and intestinal derangement, and by 
modified nutrition in general; and another striking point of similarity is 
the presence of urate of soda in the concretions, which are met with in 
the joints of those who have suffered from repeated arthritic attacks. 
Lithic or uric acid was at one time supposed to exist in the urine only, 
and it is the constituent of one form of urinary calculi ; yet, in gouty 
cases, it is separated from the blood by other organs than the kidneys ; 
and we are, consequently, compelled to infer, that in calculous cases 
the disease may not merely consist in faulty secretion by those organs, 
but that the blood may contain elements, which can be combined in 
other secreting organs ; and they clearly are so, in the case of gouty 
concretions. In the treatment of calculous cases, therefore, it becomes 
a matter of moment, that our attention should not be directed exclu- 
sively to the kidneys, but that it should be extended to the state of 
the whole system ; and experience exhibits the correctness of this doc- 
trine. 

The results of the chemical researches of Liebig led him to infer, 
that when uric acid is subjected to the action of oxygen under certain 
conditions, it undergoes a metamorphosis, whence, amongst other mat- 
ters, oxalic acid results. " Calculi, containing uric acid, or oxalic acid," 
he says, " are never found in phthisical patients ;" — a rule, however, 
which requires fresh observations before it can be considered absolute ; 
— and he adds: — " it is a common occurrence in France, among patients 
suffering from calculous complaints, that when they go to the country, 



ANTILITHICS. 293 

where they take more exercise, the compounds of uric acid, which were 
deposited in the bladder during their residence in town, are succeeded 
by oxalates, (mulberry calculus,) in consequence of the increased supply 
of oxygen. With a still greater supply of oxygen, they would have 
yielded, in healthy subjects, only the last product of the oxidation of 
uric acid, — carbonic acid and urea." 

The two chief calculous diatheses are — the lithic or uric, and the 
phosphatic. The former is usually attended by a state of the urine, 
vvhich reddens litmus paper; by yellow, red, lateritious, or pink de- 
positions of lithate of ammonia ; or by the appearance of red gravel, 
which consists of crystals of lithic acid, or, of white sediment of lithate 
of soda. In the latter, the urine is usually pale ; at times alkaline ; and 
there is a deposition of white gravel, or crystals of phosphate of mag- 
nesia and ammonia ; or the white sediment contains the mixed phosphate 
of magnesia, ammonia, and lime. 

At times, these two diatheses do not alternate in the same individual ; 
but there is usually a great disposition for the lithic to change into the 
phosphatic. The urine becomes pale under slight causes of general, or 
gastric disorder; mixed lithic and phosphatic deposits occur, or an iri- 
descent pellicle of triple phosphate forms upon its surface. — (Dr. Mar- 
shall Hall.) At length, the urine becomes alkaline, and white gravel 
is deposited. The phosphatic diathesis is now confirmed. 

These are the chief diatheses, but others may be enumerated. For 
example, the crystals of the triple phosphate are apt to be changed for 
a pulverulent deposit of that phosphate, mixed with phosphate of lime. 
This mixture constitutes the fusible calculus, and into it all the other 
forms of calculous diathesis have a tendency to pass. Again, a diathesis 
exists, in which the mulberry calculus or that which consists of oxalate 
of lime may be formed. 

From different data, examined by Dr. Prout, it appears that lithic acid 
predominates in more than one-third of the whole number of urinary 
calculi ; and very generally it forms the nucleus even of other varieties. 
It would seem, consequently, that the deposition of lithic acid is a pri- 
mary step in the formation of urinary calculi, and that the phosphatic 
and oxalatic formations are the result of a gradual transition from the 
lithic to the phosphatic or oxalatic diathesis. In the progress of this 
transition, the lithic acid deposition is, in the first instance, changed into 
one of lithate of ammonia, with a loss of the tinge derived from the 
colouring matters of the urine. After some time, this last gives place 
to a sediment, which is chiefly composed of carbonate and phosphate of 
lime ; and this is ultimately succeeded by a deposition of the phophates 
of lime and magnesia, in combination with ammonia. From all his 
inquiries on the interesting subject of urinary depositions, Dr. Prout 
conceives himself warranted in deducing the general law, — " that in uri- 
nary calculi, a decided deposition of the mixed phosphates is never 
followed by other depositions." 

Any unusual formation of acid in the stomach, or elsewhere, may be 
the cause why lithic acid is deposited from the urine. If we add acid to 
healthy urine, it is thrown down in small reddish crystals. The lithate 



294 ANTILITHICS. 

of ammonia, which exists in the urine, is decomposed ; the acid, which 
we add, lays hold of the base ; and lithic acid is deposited. We can 
thus understand, that a deposition of lithic acid crystals may be an evi- 
dence of acid dyspepsia. In this last affection, again, as well as in 
other states of the system, there may be an undue formation of lithic 
acid or of lithate of ammonia,— as in those labouring under the lithic 
acid diathesis, — and calculus, or gravel may be deposited from such 
redundancy. 

Therapeutical Application of Antilithics. 

After what has been said, the remedies belonging to the class of 
antilithics will be sufficiently apparent. Whenever, from the appearances 
presented by urinary deposits, and- by the concomitant symptoms of 
lithiasis, it is manifest, that lithic acid or lithates are separated from the 
urine in undue quantity, remedies of the alkaline class should be em- 
ployed to neutralize any predominant acid; and, along with these, tonic 
and revulsive means for improving the general health. Dr. Prout has 
shown, that when the lithic acid diathesis exists, and the urine is con- 
stantly acid, high coloured, and concentrated, repeated doses of alkalies 
not only render the urine alkaline, but keep it so as long as they are em- 
ployed. With these views, liquor potassas, or carbonates of potassaand 
soda are administered, with some vegetable tonic, and a thorough change 
of all the physical and moral circumstances surrounding the individual, 
— if this be practicable, — is recommended. Change of air, of society, 
and scenery, must, indeed, be regarded as amongst the most important 
agents, not only in the lithic acid — but in every kind of calculous — dia- 
thesis. The importance, too, of keeping up a free cutaneous exhalation 
is obvious. The perspiration is acid, and if this acid be not exhaled, 
its retention in the system may give rise to the acid predominance of 
which mention has been made. On these grounds, it has been affirmed 
by Dr. Wilson Philip, that dyspepsia tends to increase the deposition of 
lithic acid, and to lessen that of the phosphates, both by producing 
acidity of the prima viae, and by rendering the skin inactive; and that 
indolence has the same tendency, both by inducing dyspepsia, and by 
lessening the activity of the skin, in proportion as it impairs the vigour 
of the constitution. 

Dr. A. T. Thomson asserts, that lithic acid, in a healthy condition of 
the habit, is freely thrown off by the cutaneous exhalants ; but he pro- 
bably has not sufficient ground for the assertion ; nor is it necessary to 
suppose the exhaled acid to be the lithic — to account for the increased 
deposition of lithic acid from the urine, in the cases we have been con- 
sidering. Any acid predominance may induce the same effect. 

It was affirmed by Mr. A. Ure, that hippuric acid is found in the 
urine after benzoic acid had been taken ; and that the quantity of lithic 
acid is thereby diminished. Hence, benzoic acid was recommended 
by him in cases of the predominance of lithic acid. The observations 
of chemists have not, however, confirmed this. On the contrary, they 
have shown, that although benzoic acid appears to be converted into 
hippuric, there is no diminution in the quantity of lithic acid. Neither, 



ANTIL1THICS. 



295 



therefore, in the lithic acid diathesis, nor in cases of the formation of 
gout stones or tophaceous deposits, — the chief constituent of which is 
lithate or urate of soda, — can the administration of benzoic acid be ad- 
vantageous. Since then, phosphate of ammonia has been proposed 
on equally faulty theoretical considerations for the removal of the lithates 
of soda and lime, which have been considered^ to constitute the matter 
of gout. The evidence in support of the good effects of this agent in 
gout and rheumatism are given in another work, (New Remedies, 5th 
edit. p. 65, Philad. 1846,) and as subsequent experience has neither 
established the theoretical nor practical views adduced in its support as 
a remedy in lithuria, it is not necessary to say more of it here, than that 
the dose in which the salt is given is "from ten to twenty grains, three 
times a day, dissolved in water. 

A suggestion has been made by Dr. Golding Bird,— founded on\ 
the remarkable solvent action of phosphate of soda on uric acid, 1 
to which Liebig has directed attention,— to administer the phosphate ^ 
in solution, sufficiently diluted,— a scruple to half a drachm, for ex- / 
ample,— in any vehicle, as broth or gruel. In two cases, its admi-/ 
nistration .appeared to Dr. Bird to be followed by manifestly good' 
e fie c t s . 

The causes that give rise to the deposition of the phosphates 
are of a different character. In healthy urine they are considered by 
Berzelius to be held in solution by free phosphoric and lactic acids ; 
and, if any thing interferes with the presence of these acids in due 
quantity, the phosphates are deposited. Dr. Prout offers another ex- 
planation, which is more simple and intelligible. The phosphates, he 
says, exist in the urine as supersalts, and in this state are soluble; 
but, if anything neutralizes the redundant acid, so as to reduce the 
supersalt to a neutral salt, it is then deposited,— the neutral phosphate 
being insoluble. If a few drops of ammonia be added to healthy 
urine, the phosphates are thrown down, and the cause of this depo- 
sition is differently explained by Berzelius and by Prout, according to 
their particular views ; — the former considering, that the ammonia neu- 
tralizes the free phosphoric and lactic acids ; and the latter, that it neu- 
tralizes the excess of phosphoric acid. 

The general symptoms that accompany the deposition of the phos- 
phates are often very distressing : both the physique and the moral are 
greatly implicated. Derangement of the digestive organs is a universal 
concomitant, succeeded by every symptom of impaired nutrition. In 
some cases in which the bladder has lost a portion of its muscular 
power, — as in disease of the prostate, affections of the spine, and in 
the aged, — the urine is retained so long in the bladder, that it under- 
goes partial decomposition ; ammonia is generated, and a deposition of 
the ammoniaco-magnesian phosphates takes place. 

As far as regards the use of chemical remedies, the selection for the 
phosphatic diathesis is clear. That which is proper for the lithic acid 
diathesis would be obviously injurious in this: accordingly, alkaline 
remedies have to be avoided, whilst acids, — especially mineral acids, — 
can be administered with great advantage. They may not only pass 



296 LITHONTHRYPTICS. 

into the blood, and act chemically on that fluid, but invigorate the di- 
gestive apparatus, and prevent fresh deposition. 

In cases of alternating calculi, the treatment has necessarily to be va- 
ried, according to the character of the deposition, — acid or alkaline reme- 
dies being given according as the deposits are at the time phosphatic, or 
of lithic acid ; but in the depositions of oxalate of lime, nothing but ge- 
neral management can offer any prospect of benefit. There is no che- 
mical antilithic available in these cases. All that can be done in this, 
as well as in the other forms of the calculous diathesis — when invete- 
rate — is to inculcate the necessity of a thorough change of the physical 
and moral influences surrounding the individual, so as to break in upon 
the morbid catenation as effectively as possible. With this view, tra- 
velling air, and exercise are recommended,— with all their revulsive 
accompaniments ; well regulated diet and regimen ; attention to the 
condition of the bowels, and every thing that can induce tone in the 
economy generally. By thus modifying the whole system of nutrition, 
the calculous diathesis may occasionally be got rid of; and no farther 
signs of lithiasis may occur, even when the individual has been pre- 
viously strongly disposed to, and even labouring under, calculous depo- 
sitions. If the views of Liebig, however, be correct, (p. 292,) it would 
seem, that in the case of lithic depositions, country air would be inju- 
rious to residents of towns by converting the depositions into those of 
the oxalates : — but this matter cannot be considered settled. In the 
case of an intelligent medical gentleman from the interior of Maryland, 
who consulted the author many years ago, phosphatic depositions, 
which were copious, were invariably corrected by the free use of sac- 
charine aliment. 

From what has been said, we can fully understand the agency of 
tonics and astringents, when employed as antilithics. But it has been 
imagined, that certain bitters, which combine an astringent principle, 
are peculiarly adapted for such cases ; — this principle being presumed to 
enter the circulation, and to act more particularly on the kidneys. At 
one time, indeed, it was believed — it need hardly be said erroneously — 
that such vegetables possess chemical or solvent properties. Of these 
tonics, presumed to operate especially as antilithics, the leaves of diosma 
crenata or buchu ; the root of pareira brava, and the leaves of uva ursi 
have been chiefly recommended ; but the author is not prepared to cor- 
roborate the once prevalent, but now generally exploded, idea, that they 
produce other results besides those of acting as astringent tonics on the 
stomach, and of improving the gastric functions. (See, on the nature 
and therapeutics of calculous depositions, the author's Practice of Me- 
dicine, 3d edit. i. 704, Philad. 1848.) 

2. Li thonthry piles. 

Thus far of antilithics.— Not much can be said of lithonthryptics or 
solvents of calculi. The fact, that certain mineral waters, as the Vichy, 
render the urine alkaline, could scarcely fail to suggest their use in cal- 
culous affections. It would not seem, that the destruction of calculi by 
that water is effected merely, or perhaps chiefly, in the way of solution ; 



LITHONTHRYPTICS. 297 

but that it is accomplished in a very considerable degree, especially as 
regards those of the triple phosphates, by a kind of disintegration of 
their component particles. When calculi consist of the oxalate or phos- 
phate of lime, mingled with lithic acid, lithate of ammonia, or the triple 
phosphate, Vichy water is said to attack and disintegrate them rapidly. 
These waters contain a large amount of free carbonic acid, and nearly 
a drachm and a half of bicarbonate of soda in every thousand drachms 
of the menstruum. Besides greatly increasing the quantity of the urine, 
they exert a decided influence on its chemical constitution ; rendering 
it rapidly neutral if previously acid, and afterwards alkaline: from 
being high-coloured it becomes pale, and, having deposited copiously, 
becomes limpid and transparent. The experiments of several observers 
are certainly encouraging ; and suggest the importance of employing 
the fictitious waters of Vichy where the natural water is not attainable. 
A formula for these is given hereafter. 

Under views analogous to those which have suggested the use of the 
alkaline mineral waters, the different alkalies and alkaline earths have 
been freely administered as lithonthryptics. It is not probable, how- 
ever, that either the mineral waters in question, or the alkalies, can 
generally be productive of benefit, except where the depositions are of 
lithic acid or the lithates. Still the fact must be borne in mind, that 
under the protracted administration of such waters, and likewise of 
alkalies, combined with the free use of diluents, calculi of other kinds 
have experienced disintegration. Where, too, these agents have failed 
to dissolve or break down the calculus, they would seem to have greatly 
mitigated the concomitant sufferings. 

Solvents might be brought into immediate contact with vesical calculi 
by injection ; and, in this way, alkalies and acids, properly diluted, 
have been employed. Experiment seems to have shown, that the blad- 
der cannot bear the presence of an alkaline solution sufficiently strong 
to dissolve a lithic acid calculus; but it would appear from the experi- 
ments of Sir Benjamin Brodie, that loose concretions of the phosphates 
and of carbonate of lime may be acted upon by a weak solution of 
nitric acid, and thus be gradually removed from the bladder. The 
strength of the solution employed by Sir Benjamin was two minims and 
a half of the acid to a fluid ounce of distilled water. The injection 
was sent through a cannula of pure gold. It occasioned no pain: the 
patients experienced relief frOm all their symptoms ; the quantity of ad- 
hesive mucus from the lining membrane of the bladder was diminished ; 
and the constant desire to empty the organ much abated. By testing 
the fluid that had been used with a concentrated solution of ammonia, 
phosphates were abundantly precipitated, — proving that the calculi had 
been acted upon. 

It has likewise been proposed by MM. Prevost and Dumas to em- 
ploy galvanism for the decomposition of calculi in the bladder, by pass- 
ing wires, connected with the poles of a galvanic apparatus, into that 
viscus; — but the proposition has received little attention. It is pro- 
bable, indeed, that any electrolytic power, which could be introduced 
within the bladder in this way, would be apt to act upon the organ 



298 SPECIAL ANTILITHICS. 

itself, and, consequently, not be devoid of danger. Cystitis is an affec- 
tion to be apprehended from all such agents. 

The most important lithonthryptics belong to the domain of surgery, 
and do not, therefore, fall under consideration in this work. It seems 
clear, from the experience of practitioners on both sides of the Atlantic, 
that there are cases which admit of urinary calculi being broken down 
in the bladder, by the introduction of contunding instruments into that 
organ, without the bladder necessarily suffering ; and the operation of 
lithotrity, or lithothrypsy, or lithotresis, must be included amongst those 
improvements, for which the philanthropist has to thank the genius and 
daring of the modern surgeon. 



SPECIAL ANTILITHICS. 

1. Acid Antilithxcs. 

The circumstances under which acids are advisable in calculous de- 
positions have been pointed out already, (p. 295.) It was there shown, 
that they are eminently serviceable in the white or phosphatic ; whilst 
they cannot fail to augment the lithic. 

Of the Mineral Acids, either the sulphuric, the muriatic, or nitric 
may be prescribed ; but preference is usually given to the two first,— 
under the notion, derived, perhaps, from too limited experience, that 
the last disagrees with some stomachs. It has been given, however, in 
large doses without any such inconvenience. Muriatic acid would seem 
to be the most congenial, inasmuch as it is one of the acids always se- 
creted in the healthy state of the stomach, and, therefore, taken at times 
with impunity even by those who suffer from acidity. In neutral or 
alkaline indigestion, as it is termed, which is occasionally mistaken for 
acid indigestion, this acid is a great remedy. 

Muriatic acid may be given in the dose of from t»lx. to i^lxl. in any 
demulcent drink; and during its administration — indeed, whenever 
acids of any kind are given — the urine must be carefully inspected ; 
and if any signs of the lithic depositions appear, the acid must be dis- 
continued. 

Both in the case of children and adults, the careful use of mineral 
acids is to be preferred ; if for no other reason, on account of the un- 
certainty that exists in regard to the modus operandi of (he Vegetable 
Acids. It is a common belief, that the latter are decomposed; and, 
accordingly, a difficulty may exist in knowing whether they may be 
beneficial or the contrary. Observation ought to settle this question ; 
but it has not yet done so. Hence, the ordinary mineral water or soda 
water of the shops may be an equivocal remedy in phosphatic deposi- 
tions, so far as regards its chemical agency ; yet it may be of essen- 
tial service through the gentle stimulation, which it gives to the diges- 
tive function. , Lactic acid has been suggested by M. Ma^endie 
owing to the facility with which it dissolves phosphate of lime & From 



LIQUOR FOTASSJE. 299 

one to four fluidrachms of it may be dissolved in a quart of water, sweet- 
ened with two fluid ounces of syrup, and taken as lemonade.j >J t 

2. Alkaline Antilithics. 

Alkalies, as already remarked, are indicated in cases of lithic depo- 
sitions ; in which they seem to prove beneficial, not only by their action 
in the stomach as antacids ; but likewise by passing into the mass of 
blood, and being separated by the kidneys. That they do act in the lat- 
ter manner is shown by the fact, that after they have been administered 
for some time, the urine, from being acid, is rendered alkaline. In a 
state of health, indeed, the constant use of alkalies may occasion the 
deposition of white or phosphatic sediments. Mr. Brande has affirmed, 
that he has known " soda water, exhibited in a case of stone in the 
bladder, produce abundance of white sand ; which the ignorance of 
the patient and his medical attendant led them to refer to the solvent 
power of the medicine upon the stone, which they thought was gradu- 
ally giving way and being voided ; whereas great mischief was doing, 
by giving the urine more than its usual tendency to deposit the phos- 
phates, and, consequently, to augment the size of the calculus." It 
would be singular, however, were the effect, in this case, to be refera- 
ble to the action of the soda water, which, as generally sold in the 
shops, contains no alkali whatever, and is in reality acid by its impreg- 
nation with carbonic acid. 

Liquor Potass^e, Solution of potassa, was at one time more em- 
ployed as an antilithic and lithonthryptic than any of the alkalies. An 
objection urged to the pure alkalies is, that they are apt to induce irrita- » 
tion in the lining membrane of the stomach ; and such may be the case 4 
if they are given in very large doses. It must be recollected, however, 
that more or less acid is generally present in that organ, by means of 
which a portion, and, in particular cases, the whole of the alkali admi- 
nistered may be neutralized. Cases too, are recorded, in which the 
potassa has been administered for a long period, and in considerable 
quantity, without the supervention of any disagreeable results. A pa- 
tient of Dr. Marcet took it regularly for ten years, and during that time 
passed many calculi, all of which had their angles rounded, and their 
edges blunted, " in a manner, which could hardly be explained, except 
from the long continued effect of the alkaline medicine." Still, the 
bicarbonates of the alkalies are devoid of the causticity of the pure 
alkalies, whilst they have the same antilithic properties. They ought, 
consequently, to be preferred. 

The dose of Liquor Potassae is ^lx. to ^Ixxx. given two or three times 
a day in water. Veal broth and table beer have been recommended as 
vehicles, but although the latter disguises the urinous and unpleasant 
odour of the alkali, the acid of the beer may neutralize a portion of it ; 
and the beer itself is but little calculated for the phosphatic diathesis. 
An empirical remedy for stone, known under the name of l Dr. Chit- 
tick's nostrum ,' is said to be a solution of alkali in veal broth. 



300 SPECIAL ANTILITHICS, 

Carbonates of Potassa and Soda are milder preparations of the 
alkalies, and yet at least equally effective antilithics with the pure alkali. 
Bicarbonate of soda is the rnost agreeable, and is probably as efficacious 
as any ; yet the use of potassa has appeared to prove beneficial in cal- 
culous affections, where soda failed to afford any relief; and it is im- 
portant to bear in mind a fact mentioned by Dr. Prout, that the urate of 
potassa is a soluble salt, the urate of soda less so. As it is possible, 
however, that the main efficacy of antilithics may be exerted upon the 
first passages, and on the blood, rather than on the kidneys, the circum- 
stance mentioned by Dr. Prout may not be a valid objection to the use 
of soda. Sir Gilbert Blane accounted for the greater advantage of soda 
in calculous complaints by the assumption, that soda becomes applied 
to the purposes of the economy before it arrives at the kidneys; whereas 
potassa passes to those organs to be thrown off from the system. The 
dose of the carbonates of potassa and soda, as antilithics, is from gr. x. 
to 5ss ; that of the bicarbonates of the same alkalies, from gr. xx. to 
3j. They may be given in water, or in the common soda water of the 
shops. 

Ammonia and Carbonate of Ammonia are at times administered 
with the same view. Their effects would seem to be wholly exerted 
upon the primse viae ; and the same is probably the case with Magnesia, 
Carbonate of Magnesia, and Limewater. The first and second of 
these are used largely as antilithics. Magnesia was first strongly recom- 
mended by Mr. Brande, who properly remarks, that under its use in the 
lithic diathesis the red deposit in the urine becomes much diminished, 
or disappears altogether; and the irritation of the kidneys is proportion- 
f ately relieved. It must be borne in mind, however, that magnesia 
sometimes accumulates in the bowels when it is given for a long period. 
Either magnesia or its carbonate may be prescribed in the dose of from 
gr. x. to gr. xxx. in water or milk. The fluid magnesia, elsewhere de- 
scribed, (p, 159,) is a good preparation in these cases. It is a solution 
of magnesia in carbonated water. 

It is by virtue of the alkali they contain, that the Vichy waters,— 
already referred to— are so celebrated in France in calculous cases. 
Ihese are in such high repute, that they are directed to be prepared arti- 
ficially and are sent to every part of Europe ; but it need scarcely be 
said, that no artificial or real water drunk awav from the spring and 
therefore without the accompanying advantages of travelling air and 
exercise, can be regarded as substitutes for the water taken at the source. 
J he following form for the artificial Vichy water is given in the Codex 
Medicamentarms of Paris: Take of simple acidulous water, impreg- 
nated with twice its bulk of Carbonic acid, 3xxss \ Carbonate of soda 
gr. xxxij ; Sulphate of soda gr. xvj ; Chloride of sodium gr. iv ■ Carbo- 
nate of magnesia gr. ss ; Chloride of iron gr. J.— M. 

In this country, the Saratoga waters constitute an excellent remedy 
and not the less so from the slight impregnation of iron, which they 
contain. J 



DIOSMA. 



301 



3. Tonic Jintilithics. 



1. DIOS'MA.— BUCHU. 



The Pharmacopoeia of the United States, along with those of London 
and Dublin, refers Buchu leaves to Diosma crenata, whilst the Edin- 
burgh Phharmacopceia assigns them to various species of Barosma. 
" This drug" — says Dr. Christison — " furnishes a good illustration of the 
inconvenience of attempting a correct botanic nomenclature of the articles 
of the Materia Medica. It has been known in Britain for about twenty- 
years under its original Hottentot name of Buckhu or Buchu ; but the 
London College had scarcely admitted it into the Pharmacopoeia under 
the botanical name of Diosma, before botanists discovered that the plant 

or plants from which it 
Fi s- 65 - is obtained must be re- 

moved into a new genus, 
now termd Barosma" 

Barosma crenata, Sex. 
Syst. Petandria Mono- 
gynia ; Nat. Ord. Ruta- 
ceae, is a native of South- 
ern Africa near the Cape 
of Good Hope. Several 
species of Barosma are 
used by the Hottentots on 
account of their odorous 
and medicinal virtues. A 
powder, with which they 
4. Seeds. 5. Dots anoint their bodies, is 
composed of various 
odorous matters, and chiefly of Barosmas. They are small shrubs, which 
have a heavy and peculiar smell ; hence the name Barosma — from Pa%u$, 
' heavy,' 'powerful,' and o?^, « odour;' by some, the odour has been 
considered < divine,' — hence the name Diosma, from &oj, < divine,' and 
o#«7, * odour.' 

Buchu leaves — as met with in the shops — are those of several species 
of barosma, intermixed with stalks and fruit. They are smooth, some- 
what shining, sharply or bluntly serrated or crenated, and are studded 
with little oil vesicles, containing the essential oil, which gives them a 
portion of their odour. The taste of the leaves is aromatic, somewhat 
pungent, bearing some resemblance, according to Buchner, to pepper- 
mint. Some compare it to rue ; others to rosemary ; others to cumin ; 
and others, again, to the urine of the cat. (Pereira.) The main con- 
stituents, afforded by analysis, are a volatile oil of a yellowish-brown 
colour, and lighter than water, which has the odour of the leaves, — and 
a bitter extractive matter, Diosmin. The leaves afford their virtues to 
both water and alcohol. 

The medical properties of diosma, like those of the other articles 
under this head, have been greatly exaggerated. By virtue of the 




Barosma crenata. 
J. Calyx. 2. Styles and sligma. 3. Fruit, 
on leaf. 



302 SPECIAL ANTILITHICS. 

volatile oil, they are excitant, and perhaps slightly diuretic ; and, by 
their bitter extractive, tonic. They are, consequently, adapted for 
giving tone to the digestive organs, and through them to the general 
system ; but the evidence is utterly inadequate to show, that they have, 
otherwise, any effect in calculous diseases ; or that they possess any 
special action on the urinary organs. Dr. Wood, of Philadelphia, has 
correctly remarked, that " they are chiefly given in complaints of the 
urinary organs, such as gravel, chronic catarrh of the bladder, morbid 
irritation of the bladder and urethra, disease of the prostate, and reten- 
tion or incontinence of urine from a loss of tone in the parts concerned 
in its evacuation;" — and he might have added, — that we are not in 
possession of any remedy which could act beneficially in diseases 
of such opposite characters. The suggestion, that in lithiasis, attended 
with increased secretion of uric acid, diosma should be given in com- 
bination with alkalies, is good, inasmuch as in this manner we neu- 
tralize any predominance of acid ; whilst, at the same time, we give 
tone to the system ; and thus^remove the tendency to its fresh genera- 
tion. 

The dose of the powder is from gr. xx. to Jss. 

MU'SUM MOS'Ml, INFU'SION OF BUCHU, {Diosmx % ; Jlq. bullient. Oj.) 
Dose, f.^j. to f.^ij. 

The Dublin Pharmacopoeia has a Tincture of Diosma, (Diosm. ^v ; 
JllcohoL dilut. Oij ; — made either by maceration or percolation,) the 
dose of which is from f.3j to f.^ss. 

2. PAREI'RA.— PAREI'RA BRAVA. 

Pareira of the Pharmacopoeias is the root of Cissampelos Pareira, 
Pareira Brava, Velvet Leaf; Sex. Syst. Dicecia Monadelphia ; Nat. 
Ord. Menispermaeese, a climbing plant, which is a native of South 
America and the West India Islands. The root — as met with in the 
shops — is in roundish pieces, from half an inch to four inches in 
diameter ; from four inches to some feet in length, and often split longi- 
tudinally. The epidermis is thin, of a brown colour, furrowed longitu- 
dinally, and wrinkled transversely. The interior of the root is of a 
yellowish colour, very porous, and marked by irregular concentric cir- 
cles. It is devoid of smell ; and has a sweetish, and afterwards a 
nauseous bitter taste. The active principle of the root is considered to 
reside in a yellow bitter matter, which is soluble in both alcohol and 
water. A new vegetable alkaloid principle has been separated by 
Wiggers, to which he gave the name Cissampeli'na ; whose properties 
have not been described. 

Pareira yields its medical virtues to water ; hence, an extract, and 
an infusion are officinal in the London and Edinburgh Pharmaco- 
poeias. The Pharmacopoeia of the United States has no officinal prepa- 
ration of it. The same properties have been assigned to it as to diosma ; 
with the addition that it was at one time highly extolled as a lithon- 
thryptic ; and it was even affirmed that calculi — of the size of an olive 



PAREIRA. 



303 




Cissampelos Pareira. 
1. Separate flowers. 2. Embryo. 



3. Calyx. 



— had disappeared under its administration. The author has carefully 
watched its effects ; but Figt 66> 

neither in its general 
action on the system ; 
in its effects on calculous 
depositions, nor in chro- 
nic diseases of the uri- 
nary organs, has he seen 
any other propertiesthan 
those exhibited by the or- 
dinary bitter tonics; and, 
where different results 
have supervened in the 
practice of others, it is 
probable that they were 
owing to the system of 
medication combined 
with it. He has not had 
the shadow of a reason for believing it — as suggested by Dr. Christison 
— " to possess specific vir- Fi(T# 67# 

tues over various disorders j 

of the urinary organs, more 
especially chronic inflamma- 
tion of the bladder." " A 
careful inquiry into its phy- 
siological action," says the 
writer just cited, " is much 
wanted ; for some have 
failed to observe the diuretic 
and aperient properties as- 
cribed to it by others ; and 
they are disposed to think, 
as would be anticipated 
alike from its sensible qual- 
ities, and its plate in the 
natural arrangement of vegetables, that it is nothing else than an excel- 
lent tonic bitter akin to calumba. The authority of Sir B. Brodie, who 
has recommended it in chronic urinary diseases, and especially in 
chronic inflammation of the urinary bladder, has of late brought it into 
general employment. The information communicated to me on this 
point by various surgeons here who have macfe trial of it is not in its 
favour." 

Sir Benjamin recommends a decoction prepared by simmering four 
ounces of the root in three pints of water, until the fluid is reduced to 
two pints. From six to twelve fluidounces of this decoction may be 
taken in the twenty-four hours; but it is important to add, in judging 
correctly of its virtues, that Sir Benjamin is in the habit of adding to it 
tincture of hyoscyamus ; and where there is any deposition of triple 
phosphates, indicated by milky urine, with an iridescent pellicle on the 






Cissampelos Pareira. 

1. Raceme of flowers. 2. Separate raceme. 3. Section of 
ovary. 



304 



SPECIAL ANTILITHICS. 



surface, he adds muriatic or nitric acid, — agents which are themselves 
valuable antilithics. 

Infusum Pareirje of the London and Edinburgh Pharmacopoeia is 
made by macerating six drachms of Pareira in a pint of boiling water. 
The dose of this is from f.§j to f.^iij. Extractum Pareirje of the 
same pharmacopoeia is prepared in the same manner as extract of gen- 
tian. Its dose is gr. x. to 3ss ; and it is often' given along with the 
Infusion. 



3. UVA URSI. 

Uva Ursi, in the London and United States Pharmacopaeias, is the 
Fig. 68. officinal name of the leaves of Arbutus 

Uva Ursi, Jlrctostaphylos Uva Ursi, 
Bearberry, Bear's Whortleberry ; Sex. 
Syst. DecandriaMonogynia ; Nat. Ord. 
Ericaceae ; a low evergreen shrub, which 
is a native of the northern latitudes of 
Europe, Asia and America. On the 
American continent, it extends from 
Hudson's Bay as far southward as New 
Jersey, whence it is obtained for the 
market of Philadelphia. (Wood & 
Bache.) The leaves are gathered in 
autumn, and the green ones are selected. 
— They are apt to be mixed with Vac- 
cinium Vitis Idsea, Red Whortleberry , a 
plant of the same natural family, the 
leaves of which are minutely toothed, 
and the under surface dotted ; whereas 
the edges of the genuine leaves are en- 
tire and the under surface reticulated. 
Moreover, the spurious leaves are defi- 
cient in astringency^ a remark which 
applies to the box-leaf, which is sometimes mixed with it ; — the true 
uva ursi leaf having a bitterish and strongly astringent taste ; but no 
odour except when in powder. It then resembles that of hay. Its vir- 
tues which are mainly dependent upon tannic acid, are yielded to 
water and alcohol. The tannic acid — as elsewhere observed — is the 
great astringent principle of vegetables. 

Uva Ursi is possessed of the powers of the ordinary astringents ; but, 
so far as the author has observed, of nothing more ; yet it has all the 
virtues ascribed to it that have been assigned to Diosma and Pareira. 
It has, indeed, been regarded " as a specific in diseases of the kidneys 
and bladder at large." " In recent times," says Dr. Christison, " it 
has been succeeded, as a panacea, in urinary diseases, by the Pareira 
brava root — probably" — he gravely adds, " without sufficient reason." 
Nothing can be more feeble than the testimony which has been brought 
forward in favour of its specific affinity for the urinary organs, and ac- 




Arbutus Uva ursi. 

1. Anthers. 2. Single anther, showing 
spurs. 



DIAPHORETICS. 305 

cordingly the confidence of surgeons in regard to it is becoming less and 
less ; at all events their sentiments are highly discordant. As an antili- 
thic it appears to act solely by its tonico-astringent properties. 

The dose of powdered uva ursi is from 9j to 3j, given three or four 
times a day ; but the form usually preferred is, 

DECOC'TM UYiE URSI, DECOCTION OF UVA URSI. (Uvsb ursi |j ; Aqua 
fjxx. Boil to a pint). The dose is from f.§j to f.§ij, three or four 
times a day. 



V. DIAPHORETICS. 

Synon. Diapnoica. 

Definition of diaphoretics — Largely invoked in Therapeutics — Disease not often induced by 
suppressed perspiration — Modus operandi of diaphoretics — Are indirect agents — How 
their operation may be aided — Their therapeutical application — Special diaphoretics. 

Diaphoretics are defined to be — " agents that augment the function 
of transpiration." 

As it was at one time imagined, that almost every disease, to which 
mankind are liable, is produced by obstructed perspiration, the class of 
diaphoretics was extensively employed in medical practice, and numer- 
ous agents were admitted into the catalogues of the materia medica, 
which were supposed to be capable of augmenting the cutaneous exha- 
lation. Even yet, this cause of disease is repeatedly referred to, not 
only by the unprofessional, but by many of the profession. " Health," 
says a modern writer — Dr. Eberle — " is very intimately connected with 
the regular performance of the perspiratory function. Whenever the 
transpiration by the skin is suddenly checked, more or less derange- 
ment of the system is invariably the consequence. That portion of the 
circulating fluid, which nature designs to be cast off by the cutaneous 
emunctories, is no longer fit for the purposes of the animal economy ; is 
retained and becomes a source of morbific irritation to the heart and 
other organs." " Disease," says 4 another writer — Dr. A. T. Thomson — 
1 'is frequently the consequence of a sudden check to the perspiratory 
function ; means, therefore, have been sought for to restore it ; and the 
substances, classed as diaphoretics, are supposed to have that power." 

It may admit of well-founded doubt, whether disease be ever induced by 
suppression of the cutaneous exhalation. The two great fluids of depura- 
tion are the transpiration— cutaneous and pulmonary — and the urine. In 
summer the former predominates ; in winter the latter. Hence, there ap- 
pears to be a sort of compensation effected between the two depurations, 
so that if one be diminished by a change of atmospheric temperature, the 
other is augmented. For this reason, we should not anticipate extensive 
morbid results from a general check given to perspiration, were we even 
ignorant of the impunity, with which we may pass from a heated apart- 
ment into the external air, as well as that which follows the use of the 
cold bath, after the individual has been exposed to a very elevated tem- 

Vol. I.— 20 



306 DIAPHORETICS, 

perature, — as in the Russian vapour-bath. Observation has sufficiently 
shown, that danger is less to be apprehended from such general checks, 
than from the partial and irregular application of cold and moisture. 
The danger of having the feet cold and wet, or of sitting with a part 
of the body exposed to a draught of cold air, is proverbial ; yet, if we 
attempt to explain this by the check given to perspiration, we fail ; for 
the loss of the ordinary depuration, in so small a. portion of the body, is 
obviously insufficient to account for the phenomena ; yet, disease is far 
more apt to be induced in such case, than when the whole body is ex- 
posed to a sudden alternation of temperature from hot to cold ; and when 
the check to the cutaneous depuration ought necessarily to be to a much 
greater extent. The author has elsewhere remarked, {Human Health, 
p. 45, Philad. 1844,) that there is perhaps in every one, at any particu- 
lar time, some organ or tissue of the body more disposed to take on 
morbid action than another; and that, between every part of the system 
of nutrition and secretion such an extensive sympathy reigns, that if one 
part be irregularly and morbidly impressed, such impression vibrates to 
every part of the system, so that the tissue or organ, most disposed to 
take on morbid action at the time, assumes it. Hence, if a dozen indi- 
viduals be exposed to the irregular application of cold and moisture to 
the feet, they may not all have the same disease induced, because in all 
there was not, at the time, the same disposition in a particular organ or 
tissue to the assumption of disease. 

This irregular nutritive action of a part is the first link in the chain 
of phenomena, — not the obstruction of perspiration. On this head, a 
modern waiter, Dr. W. F. Edwards, of Paris, has expressed himself in 
a sound and rational manner. The insensible perspiration he regards as 
a purely physical phenomenon of " evaporation," whilst the sensible " is 
a loss ordinarily produced by a vital action in the form of a liquid which 
transudes." In prosecuting the consideration of this subject, he remarks 
— "All that we have hitherto shown on the subject of perspiration will 
considerably facilitate our examination of a question which naturally 
presents itself. Is perspiration susceptible of being suppressed? It is 
easier to resolve this question with regard to man and other warm- 
blooded animals than with respect to the cold-blooded vertebrata. Let 
us see what is the result of a very low temperature upon warm-blooded 
animals. We know by the effect of cold upon the sweat, that it dimin- 
ishes transudation. Now let us suppose, that it may, by its intensity, sup- 
press it altogether, there will remain perspiration by evaporation, which 
will always take place, however humid the air may be. The high tem- 
perature of man, and other warm-blooded animals, warms the air in 
contact with the body, and changes its hygrometric state by removing 
it from its extreme of humidity ; and consequently occasions evapora- 
tion. If, on the other hand, the temperature of the air be raised to an 
equality with that of the body, at the time that it is saturated with humi- 
dity in order to suppress evaporation, then perspiration by transudation 
is excited, and takes place to such an extent in man and other warm- 
blooded animals, that the sweat will stream from all parts of the body. 
We can then, in no case, suppress the perspiration ; it will be performed 
either by evaporation or by transudation. We ought therefore to be 



ACTION OF. 307 

careful, how we take literally what we find in medical books respecting 
suppressed perspiration. There can be no such thing. That there may 
be suppression of sweat is evident to every one ; but it does not follow 
that, even in these cases, there is no transudation. 

" Since it is difficult to assure ourselves directly, whether transudation 
is ever entirely suppressed in man, and other warm-blooded animals, 
let us see what the cold-blooded vertebrata will offer on this point. The 
batrachians are the best adapted to this kind of research, on account 
of the nakedness of their skin, of the fineness of its texture, of the 
copious loss which may be incurred through its medium, and conse- 
quently, of the relation which their perspiration bears to that of man. 
On exposing frogs to the temperature of 0° Cent. (32° Fahr.) in humid 
air, in order to suppress perspiration by evaporation, they have lost by 
transudation, in different experiments, the thirtieth part of their weight. 
Transudation is more abundant in these animals than in man, though 
the latter be placed in circumstances much more favourable. When we 
consider how sensible these creatures are to cold, how much the activity 
of all their functions is diminished at a low temperature, and how 
much they may even then lose by transudation, it is not to be 
supposed, that cold suppresses this mode of perspiration in man, and 
the less so from his having a temperature of his own, which varies very 
little with the changes of the atmosphere, a condition which has a 
powerful tendency to maintain transudation. It may be very much dimin- 
ished by the action of cold, but it appears that it cannot be altogether 
suppressed. It is a remarkable but well known fact, that when life is 
sinking, and to appearance nearly extinct, the body is covered with 
sweat — so strong is the tendency to continue this function." 

In any mode, consequently, of viewing the subject, it does not ap- 
pear that we can ascribe any extensive series of morbid phenomena to 
simple suppression of perspiration. Such being the fact, the indication 
of restoring suppressed perspiration — if it be admitted at all — must 
exist much less frequently than has been imagined. Yet there are few 
classes of remedies that are more used, especially by the older practi- 
tioners, than diaphoretics ; and probably none which are more uncertain 
in their operation, and on which less reliance ought to be placed. Most 
of them, too, are agents, which stimulate the heart and arteries ; and 
hence the indiscriminate employment of heating diaphoretics has been 
productive of much mischief in febrile and inflammatory disorders. In 
a state of health, any thing, which gives occasion to the greater propul- 
sion of blood into the cutaneous capillaries, will produce diaphoresis. 
In this way, exercise and external heat exert a diaphoretic agency ; but 
when the capillary action is in a state of exaltation from disease, the 
same agencies are not followed by a like result. This state of exalta- 
tion has to be reduced before diaphoresis can be effected. The same 
thing is also exhibited in another way. During the heats of summer, 
the cutaneous capillaries are kept in a state of perpetual erethism, and 
although the sensible perspiration may be exhaled to a great extent, it 
would probably be more largely elicited were the erethism less ; accord- 
ingly, when we take iced water or any iced drink under such circum- 



308 DIAPHORETICS, 

stances, the refrigerant influence is exerted on the capillaries of the 
stomach, and, owing to the extensive sympathy that exists between every 
part of the capillary surface, the cooling influence is at once communi- 
cated to the whole capillary system ; the erethism is thus reduced, and 
copious perspiration ensues. Every one must have observed how 
rapidly the sensible perspiration is thrown out in hot weather after the 
use of iced drinks. The effect is, in this case, diaphoresis ; but the 
remedy operates as refrigerant — a class of agents far more efficacious 
than diaphoretics. It may be doubted, indeed, whether we have any 
internal remedies, which are capable of acting as direct diaphoretics ; 
— that is, by virtue of specific properties, which they possess over the 
sudoriparous glandular apparatus of the skin. Dr. Paris thinks, that 
mercurials and sulphur act in this way, but the only evidence we have 
of this is, that they pass off by the skin ; and as they emerge from the 
system in this manner, it would be fair, perhaps, to presume, that they 
may act on the cutaneous capillaries; but we have no evidence in favour 
of their producing augmented diaphoresis. 

The author to whom allusion has just been made, has given 
the following table of what he considers the modus operandi of 
diaphoretics. 

'* Diaphoretics: 
Occasion their effects — 

I. By stimulating the cutaneous capillaries. 

a. By external application. 

The stimulus of heat, frictions , fyc: 

b. By medicines which enter the circulation and stimulate 
the cutaneous vessels by contact. 

Mercurials — sulph ur. 

c. By medicines which act on the surface sympathetically, 
through the medium of the stomach. 

Cold drinks, fyc. 

II. By increasing the general action of the vascular system. 

Violent* exercise — .Ammonia — Guaiacum — Alcohol — 
Warm bath. 

III. By relaxing the morbidly constricted mouths of the perspiratory 
vessels. 

Antimonials — Cold affusion — Venesection — Saline dia- 
phoretics." 

It has been seen, that the modus operandi of cold drinks cannot be 
referred to any " stimulation" of the cutaneous capillaries; and the 
same may be said of the warm bath, which certainly does not operate 



ACTION OF. 309 

by increasing the general action of the vascular system. Such maybe, and 
is, the effect of the hot bath, hot aqueous vapour, or hot air ; but the warm 
bath acts precisely like the cold by diminishing the action of vessels. A 
mistake is often made, and a hot stimulating bath is occasionally admin- 
istered in violent inflammatory attacks, instead of the warm and sooth- 
ing, — to the manifest detriment of the sufferer. The application of 
warmth in the form of the warm water bath is one of the most valuable 
therapeutical agents which we possess, especially in the inflammatory 
and spasmodic disorders incident to childhood. At one time, the salu- 
tary agency was universally ascribed to the restoration of suppressed 
perspiration. It is now known to modify the condition of the capillary 
system, reducing it when over-excited, and producing a beneficial action 
of equalization in the circulatory movements, so as to diminish the ex- 
altation of vital manifestations in the organ labouring under inflamma- 
tion or spasm. 

In reality, there are no substances, administered as diaphoretics, on 
whose direct agency much dependence can be placed, unless they are 
such as are made to come in contact with the cutaneous surface. Dia- 
phoresis follows the employment of many internal means, but the result 
is produced indirectly. Antimonials, for example, have been much 
relied upon for " relaxing the morbidly constricted mouths of the per- 
spiratory vessels ;" but this result is not produced by any specific action 
on those vessels, so much as by exciting a new impression on the sys- 
tem, which breaks in upon the cutaneous erethism. Perhaps, we have 
no class of remedies more uncertain in their operation than antimonial 
diaphoretics, as ordinarily administered. It might, indeed be said, that 
there are no agents so devoid of any beneficial action ; yet, if they are 
given so as to excite nausea, or a state approaching this, diaphoresis 
often results ; but then it is produced immediately by the state of 
diminished vital activity, occasioned by the remedy acting as a nauseant, 
— a set of agents possessed — as has been seen — of the most valuable 
properties for reducing morbid exaltation of the vital forces. 

The faith, however, that has existed in antimonials, as usually pre- 
scribed, for exerting a febrifuge action, has not been without its advan- 
tages. Whilst trust is reposed in them, the feverish invalid is left in 
quietness, and the irritating system of cathartic after cathartic is, for the 
time, dispensed with ; but that the antimonial is, in many cases, inert, 
has been sufficiently shown from numerous experiments with Pulvis 
Antimonialis of the pharmacopoeias — a powder introduced as a facti- 
tious " James's Powder" — which have clearly demonstrated, that the 
preparation is often almost wholly inoperative, even when given in very 
large doses. It is rarely employed on the continent of Europe ; but 
confidence is still, although unworthily, reposed in it by many practi- 
tioners of this country, and of Great Britain. " The utmost diversity of 
opinion," says Dr. A. T. Thomson, " exists respecting the utility of 
this preparation ; many practitioners contending that it is perfectly inert, 
dthers asserting, * that it is one of the best antimonials we possess.' 
From the result of its administration in my own practice, I cannot place 
any confidence in its diaphoretic powers. If there be much muriatic 
acid present in the stomach, it may prove active ; but in general it dis- 



310 DIAPHORETICS, 

plays no influence whatever on the system. It has been given in doses 
of sixty, eighty, and one hundred and thirty grains without any sensible 
effect. Its occasional activity may be ascribed to the oxide being acci- 
dentally in the state of a protoxide." The results of the author's observa- 
tions have led him to conclusions identical with those of Dr. Thomson ; 
yet he can well recollect how strongly it was urged upon him, by an old 
and venerated preceptor, to place full reliance upon six or eight grain 
doses of this preparation, in cases where a febrifuge was needed ; and 
to be especially careful not to exceed this quantity, lest emesis should 
follow. 

In every case, in which the skin is hot and dry, and the indication 
appears to be, to establish diaphoresis, the precise pathological condi- 
tion of the cutaneous exhalants must be inquired into ; and, if possible, 
removed. Hence it is, that the well-instructed practitioner employs 
1 indirect' diaphoretics rather than such as are esteemed ' direct.' Thus, 
diminished sensible exhalation takes place from the skin during the ex- 
istence of fever or of inflammation ; but the physician does not have 
recourse to any ' reputed diaphoretic,' which acts by exciting the san- 
guiferous system. He adapts his antiphlogistic remedies, so as to reduce 
the already too much excited condition of the blood-vessels to the 
healthy standard, and he finds, when he has removed the internal in- 
flammation, the heat and dryness of the skin subside, and diaphoresis 
satisfactorily established. Under similar circumstances, a full dose of 
opium is attended with a similar result. Opium, in a large dose, exerts 
sedative properties. When, therefore, inflammation is present, sedation 
is produced by the drug; nervous and sanguiferous excitation are 
allayed, and the skin becomes cool and moist. Hence it is, that mor- 
phia, in large doses, is often so powerfully diaphoretic. 

One of the most celebrated diaphoretics, or sudorifics — for the latter 
term is more frequently employed where the medicine is considered 
capable of inducing sweating — is a combination of opium with ipeca- 
cuanha. Opium, in a small dose, is stimulant ; in a large dose, sedative. 
Ipecacuanha, in a full dose, is emetic; in a small one, nauseant, and, 
by virtue of the latter property, diaphoretic. Ten grains of pulvis ipe- 
cacuanhas et opii, Dover's powder, contain one of opium ; and, under 
the combined action of the substances in this dose, augmented exhala- 
tion from the skin takes place as surely as after the administration of 
any internal diaphoretic agent. It has been the fashion to explain its 
action by supposing, that, whilst the opium increases the force of the 
circulation, the ipecacuanha relaxes the exhalant vessels, and causes a 
copious diaphoresis. This, however, is an improbable hypothesis, and 
the true explanation, perhaps, is, — that the combined influence of the 
two agents is exerted on the vascular and nervous systems so as to re- 
duce inordinate activity : in this way, the erethism of the capillaries, 
consequent on irritation existing elsewhere, is removed, and the cuta- 
neous exhalation becomes manifest. It cannot be denied, that there 
may be remedies, which may hurry the circulation, and others that may 
relax the cutaneous exhalants; but it is not easy to conceive, that they 
can be readily brought to act simultaneously, and it is easier to account 
for the induction of diaphoresis, by such compound remedies as the 



ACTION OF. 311 

pulvis ipecacuanha et opii, upon general principles, than by invoking 
specific influences, of the reality of which we must remain in strong 
doubt. 

It has been already remarked, that nauseants act as the most effective 
diaphoretics. Their operation is, of course, indirect ; their main agency 
being exerted on the nervous and sanguiferous systems, which they 
depress. 

The action of diaphoretics is aided by the free use of diluents ; but 
much of their operation is to be referred rather to the temperature of 
the fluid than to their passing into the blood-vessels, and producing 
polya?mia. The experiments of M. Magendie have shown, that if warm 
fluids be injected into the yeins of an animal, a state of artificial polyae- 
mia may be induced, during the existence of which, the pulmonary 
and cutaneous transpirations are greatly increased. Where, however, 
there is much erethism present, absorption is but feebly effected. Were 
it otherwise, inflammatory diseases could hardly fail to be largely aug- 
mented by the free use of diluents. 

On the whole, then, even in febrile and inflammatory affections, the 
use of the ordinary internal diaphoretics is uncertain, and generally of 
no avail ; whilst several of them are decidedly injurious by their excitant 
properties ; yet, in many such cases, advantage may be derived from 
the equalizing influence of the warm bath ; and, in minor inflamma- 
tions, especially of the gastro-pulmonary mucous membrane — as 
catarrh — the good effect of warm diluents, aided by the warmth and 
quietude of bed, produce an effect of equalization, which is often most 
salutary. In no disease, perhaps, has the class of medicines we are 
considering been more extensively employed than in rheumatism. Its 
pathology has always been connected with suppression of perspiration. 
Its very name denotes a rheum, a defluxion, a catarrh, directed to the 
suffering part, and the cause of such defluxion has been almost always 
referred to some check given to the cutaneous transpiration. This 
applies more especially to chronic rheumatism ; but the reasoning, and 
the practice founded upon it, have been extended to acute forms of 
rheumatism or rheumatic fever, in which the copious exudation from 
the cutaneous exhalants, notwithstanding the hot skin, is one of the 
most striking symptoms. Dover's powder has long been a favourite 
remedy in this disease ; and, when given in proper doses, is often 
useful, for the reasons previously assigned. The combination is well 
adapted for diminishing vascular and nervous action ; but the indication, 
in these cases, is surely not to restore suppressed perspiration, but 
rather to diminish 'the singular state of erethism, which characterizes 
that anomalous phlegmasia. It has been suggested, indeed, by Dr. 
Carpenter, that instead of endeavouring to check the copious acid per- 
spirations of acute rheumatism, we should rather encourage them as the 
best means of freeing the blood from its undue accumulation of lactic 
acid; and that in the * sweating sickness,' which spread so extensively 
throughout Europe in the 16th century, no remedies seemed to be of 
any avail but diaphoretics, " which, aiding the powers of nature, con- 
curred with them to purify the blood of its morbific matter." But the 
marked efficacy of full sedative doses of opium and of sulphate of 



312 



SPECIAL DIAPHORETICS. 



quinia in arresting acute and subacute rheumatism, without adding to 
the perspiration, is not in favour of this view. 

In almost all cases, in which the employment of diaphoretics appears 
to be indicated, the class of sedatives, or refrigerants, or both, will be 
found more advantageous, for reasons already assigned ; and to be more 
particularly expatiated upon, when the modus operandi of those divisions 
of remedial agents comes to be considered. 



SPECIAL DIAPHORETICS. 

I. Sedative Diaphoretics. 



1. ANTIMCNIALS. 



The preparations of antimony, that are alone used as diaphoretics at 
the present day, are tartrate of antimony and potassa ; pubis antimo- 
nialis, and precipitated sulphuret of antimony. 

a. antimo'nii et potas'sjs tartras. — tartrate of an'timony and 

POTAS'SA. V 

Tartar emetic has been regarded by many as the most certain of the 
antimonial diaphoretics ; and it is assuredly more frequently given than 
any other. When pushed to the extent of inducing nausea — like other 
nauseant emetics, it is a true and valuable sedative ; yet it is most fre- 
quently given in fever so as to produce a febrifuge effect without exciting 
nausea. In such case, as already remarked, it is an uncertain remedy, 
and nothing exhibits this more strongly than the discordant testimony 
in regard to it in continued fever. Whilst many consider it to be of 
great service ; others speak slightingly of it. " Of all the numberless 
febrile diseases," says Dr. Christison, "where antimonial diaphoretics 
are prevalently given, the only one where my own observation does not 
concur with (hat of most others as to their beneficial effects is continued 
fever. After extensive experience as an hospital physician for twenty 
years, I must say, that I have seen no substantial reason for the warm 
commendations of this method of cure by some, either in the marked 
inflammatory type put on by the disease in the earlier periods, or in the 
late typhoid form which it has assumed, or in the synochous form in 
which it appeared in the middle of the term. What may have been, 
or may yet be, the case of other epidemics, it must be left to others to 
determine. In the late epidemics of Edinburgh I have seen no wood 
done by it except as a palliative, and not a very trusty one, in abating 
reaction in the early stages of synochus and typhus." 

The ordinary dose, as a diaphoretic, is from one-sixteenth to one- 
sixth of a grain, given in solution, or in powder. By many, in this 
country, a combination of nitrate of potassa, calomel and tartar emetic 
is prescribed under the name of " Nitrous powders." The usual 
form of preparation of these is the following — {Antim. et potass, tartr 



PULVIS ANTIMONIALIS. 313 

gr. §■ ; Potasses nitrat. 9ss ; Hydrarg. chlorid. mit. gr. \ ad gr. \ M. 
One of these to be given every two or three hours. They are espe- 
cially useful, where it is desirable to touch the mouth in fever; yet it 
may be a question, whether there be any advantage from the reputed 
diaphoretics with which the mild chloride of mercury is combined. In 
the advanced stages of typhus, 'accompanied with high encephalic 
excitement, as manifested by loss of sleep, delirium, &c, good effects 
have resulted from the use of the tartrate combined with opium ; yet 
these are precisely such cases as are benefitted by the use of opium 
singly ; and it has been found equally beneficial in encephalic disturb- 
ance supervening on other diseases, and associated with adynamic 
phenomena. 

VIMJI AMMO'M, ANTIMO'NIAL WINE. The dose of this solution of 
tartrate of antimony and potassa, as a diaphoretic, is from ten to thirty 
drops, repeated three or four times in the course of the day. Each 
ounce of the wine contains two grains of tartrate. 

b. pulvis antimonia'lis. — antimo'nial powder. 

Dr. James, of London, about the middle of the last century, acquired 
great celebrity for a powder which was known under the name of 
Jameses Powder. This, on analysis, was found to consist of phosphate 
of lime, with about an equal quantity of oxide of antimony. In accord- 
ance with this analysis, a preparation was introduced into the London 
Pharmacopoeia, which resembles in its ingredients the real James's 
powder, but differs in their proportion. The London Pharmacopoeia 
has the following directions for its preparation. Take of Sesquisulphu- 
ret of antimony, in powder, a pound ; Horn shavings, two pounds : 
mix and throw them into a red-hot crucible, and stir constantly until 
vapour ceases to arise. Rub the residue to powder, and put it into a 
proper crucible. Then apply heat raised gradually to redness, and 
keep it so for two hours. Rub the residue into a very fine powder. 
By this process, the animal matter of the horn is burnt away ; and the 
subphosphate, with a little of the carbonate of lime, is left. The sul- 
phur of the sesquisulphuret is expelled by the same agency in the form 
of sulphurous acid, whilst the antimony takes oxygen from the air, 
forming antimonious acid, and sesquioxide of antimony. The main 
constituents, therefore, are antimonious acid and subphosphate of lime. 
It is of a white colour, tasteless, and devoid of odour. 

Antimonial powder, as already remarked, is extremely uncertain 
in its operation, and is generally wholly inert: for these and other 
reasons it has not been received into either of the two last editions 
of the Pharmacopoeia of the United States. Its ordinary dose is from 
three to ten grains and more, repeated three or four times in the course 
of the day. It may be given in pill, or in thick sugar and water. 

Some practitioners have more confidence in the empirical "James's 
powder ;" but it, also, is uncertain in its operation ; and, accordingly, 
neither the one nor the other is much used at this time, in this country. 



314 



SPECIAL DIAPHORETICS. 



C. ANTIMo'NII SULPHURe'tUM PR^CIPITA'TUM. — PRECIP'lTATED SUL- 
PHURET OF ANTIMONY. 

The mode of forming this preparation, in the Pharmacopoeias of 
Great Britain and the United State's, consists in boiling sulphuret oi 
antimony, and solution of potassa in distilled water for three hours, 
constantly stirring, and occasionally adding distilled water, so as to 
preserve the same measure. The liquor is then strained ; and, while 
hot, diluted sulphuric acid is dropped in, as long as it produces a pre- 
cipitate ; the sulphate of potassa formed is then washed away with hot 
water, and the precipitated sulphuret of antimony is dried and rubbed 
into fine powder. 

Several old antimonial preparations were at one lime largely em- 
ployed ; one of these was Kermes mineral. It is formed by boiling 
sesquisulphuret of antimony in an alkaline liquid, and allowing a red- 
dish powder, — kermes mineral, — to be deposited on cooling. If to the 
filtered mother liquor, a dilute mineral acid be now added, the golden 
sulphuret of antimony — an orange-red precipitate — is thrown down ; 
and if the acid be added before the kermes mineral has subsided, an 
orange-red precipitate is deposited, which is the oxysulphuret of an- 
timony of the London Pharmacopoeia, — the golden sulphuret of 
antimony of the Edinburgh and the precipitated sulphuret of anti- 
mony of the United States Pharmacopoeia. This substance is de- 
void of smell, and of a slightly styptic taste. It is insoluble in water ; 
but is wholly soluble in nitrochlorohydric acid, with the evolution of 
hydrosulphuric acid. 

Precipitated sulphuret of antimony is not inert. It has been given 
as an emetic ; but, like Pulvis antimonialis, is so uncertain in its opera- 
tion, that it is rarely used. It was an ingredient in Plummets Pill, and 
is therefore still retained in Pilulse Hydrargyri Chloridi Composite of 
the British Pharmacopoeias. The dose, as a diaphoretic, is from two 
grains to ten, repeated once or oftener in the day. 

2. IPECACUAN'HA. 

The remarks, made in regard to the tartrate of antimony and potassa 
as a diaphoretic, are equally applicable to the article under consideration. 
When given alone, it is an extremely uncertain remedy ; but when 
carried to the extent of inducing nausea, it is a valuable sedative ; and, 
by allaying excited organic actions, produces indirectly diaphoresis in 
febrile and inflammatory diseases. It is often, however, administered 
in such cases in so small a dose as to exert probably no action whatever, 
whilst at the same time, the disease may be treated upon general prin- 
ciples, and successfully. 

The dose of powdered Ipecacuanha, as a diaphoretic, is from half a 
grain to a grain; with such view, however, it is most commonly pre- 
scribed in conjunction with opium, as in the officinal preparation : — 



opium. 315 

PTJLVIS IPECACUANHA ET OPII, POWDER OF IPECACUANHA AND OPIUM.— 

(Ipecac, pulv., Opii pulv. aa 5j ; Potassae Sulphat. ^j.) This is known 
in the shops as Dover's powder, being an imitation of a well known 
formula, already referred to, which was used by Dr. Dover as a diapho- 
retic. The sulphate of potassa probably exerts little or no action on 
the economy. It serves a useful pharmaceutical purpose, by virtue of 
its hardness, — enabling the other ingredients to be minutely divided. 
Of the modus operandi of this compound powder the author has already 
spoken (p. 310). It is much used by many practitioners ; and is doubt- 
less often given in cases for which it is by no means appropriate. It is 
best adapted for those in which the concentration of vital activity on 
some internal organ is not excessive ; and where the indication appears 
to be, to allay inordinate action and to procure rest. Hence, a full dose 
in adynamic and ataxic fever is often beneficial ; as well as at the com- 
mencement of minor inflammations, as catarrh, sore-throat, &c. When, 
aided by diluents, it exerts an equalizing agency, inducing general dia- 
phoresis, and, in this manner, breaks in upon the hyperemia. In cases 
of acute rheumatism, it is freely exhibited ; and some trust to it entirely 
throughout that painful malady. Acute rheumatism, however, is gen- 
erally a self-limited disease, — running its course with but little modifi- 
cation from the remedies ordinarily prescribed ; and when Pulvis Ipe- 
cacuanhas et Opii seems to be beneficial, it is less, perhaps, from its 
diaphoretic, than soothing agency on the nervous system, which is so 
much implicated in that singular affection. 

It must be borne in mind, that when given in a large dose, the ipe- 
cacuanha may occasion vomiting ; and hence it will rarely be retained 
where nausea, or a tendency to it, exists. For the same reason, diluents 
which greatly promote its action, and which are themselves diaphoretic 
under certain circumstances, cannot be freely administered soon after a 
full dose of the powder has been taken. Where, for example, ten 
grains of the powder have been taken at bed-time to induce diapho- 
resis, as in an ordinary case of catarrh, it may be well to wait an hour, 
and then to give warm wine whey, or a simple diluent, — as tea or gruel. 

The ordinary dose of pulvis ipecacuanhas et opii is ten grains ; 
which may be repeated in the course of three or four hours. Tea or 
sugared water may be the vehicle. Ten grains contain one of opium 
and one of ipecacuanha ; but the former is probably the most impor- 
tant constituent. 

VINUM IPECACUANHA, WINE OF IPECACUANHA, (p. 128.) The dose of this 
officinal preparation, as a diaphoretic, is from ^Ix to f.Jss ; and it not 
unfrequently forms part of diaphoretic mixtures, prescribed in febrile 
and inflammatory affections. When associated with the tincture or 
wine of opium, its action resembles that of the preparation last de- 
scribed. 

3. OTIUM. 

The effects of this valuable drug on the nervous system generally 
are explained under Narcotics. On the nerves of the skin, its agency 
is shown by a sense of itching or pricking over the surface, and occa- 



316 SPECIAL DIAPHORETICS. 

sionally by a cutaneous eruption. When taken in very large sedative 
doses, all its preparations, but especially those of morphia — according 
to the author's experience — induce diaphoresis ; and where opium has 
been taken for the purpose of destroying life, the perspiration induced 
by it has been, at times, excessive. In a fatal case, the sheets of the 
bed were completely soaked to a considerable distance round the body. 
— (Christison). 

The effects of opium on the general system— as elsewhere shown — 
are altogether relative, and dependent upon the dose. In a small dose, 
it is excitant; in a large dose, sedative; and, accordingly, there are 
pathological conditions in which good effects might result from it in a 
large dose, whilst the same morbid condition might be aggravated by a 
smaller. For example, in febrile and inflammatory cases, a small dose 
might add to the existing evil, and render the skin more hot and dry, 
whilst a large dose might reduce the organic actions, and thus prove 
indirectly diaphoretic. The reader is, however, referred to another part 
of this work for a farther exposition of these views, the accuracy of 
which has been since admitted by Dr. Spillan. 

Opium is rarely, however, administered alone as a diaphoretic. It 
is generally combined with ipecacuanha, or tartrate of antimony and 
potassa. — See Pulvis Ipecacuanha et Opii, (p. 315). 

II. Excitant Diaphoretics. 
4. LIQUOR AMMO'NIA ACETA'TIS.— SOLU'TION of acetate of AMMO'NIA. ! 

Solution of acetate of ammonia, formerly called Spirit of Mindere- 
rus, is best prepared by saturating diluted acetic acid with carbonate of 
ammonia. If quite neutral, it produces no effect either on turmeric or 
on litmus paper: when pure, it is entirely colourless. 

Difference of sentiment has existed amongst observers in regard to 
this solution, as to whether it be excitant or sedative ; nor is the differ- 
ence confined to this point. Whilst some have the greatest confidence 
in it as a febrifuge ; others consider it to be devoid of action on the 
economy. Four ounces were taken at once ; and, soon afterwards, 
four ounces more, without any sensible effect. 

The author sometimes prescribes it in fever ; but more from its serv- 
ing a temporizing purpose, than for any marked febrifuge power which 
he considers it to possess. It is often given in other diseases of excite- 
ment ; sometimes alone, but frequently along with antimonials, nitrate 
of potassa, &c. As in the case of other diaphoretics, its action maybe 
promoted by the use of diluents, and by external warmth. The ordi- 
nary dose is from f.^ss to f.^iss, which may be repeated four or five 
times in the day. 

5. AMMO'NIA CAR'BONAS.— CAR'BONATE OF AMMO'NIA. 

Carbonate of ammonia — as elsewhere stated — is an active excitant ; 
and, like other excitants, proves diaphoretic undercertain circumstances. 
It is rarely, however, given as a diaphoretic alone; and not often in 
combination. Associated with opium, it is occasionally prescribed in 



EUPATORIUM. 317 

i 

protracted ataxic and adynamic fevers ; and in acute rheumatism, it has 
been given by some in association with guaiac, but on no very rational 
principle. At the present day, it is by no means frequently used. It is 
recommended, that its diaphoretic operation should be assisted by dilu- 
ents and warm clothing, which are themselves diaphoretic agents. The 
dose as a diaphoretic is from gr. x to 9j ; and a good vehicle for its 
administration is almond emulsion. Sugared water answers, however, 
every purpose. 

Liquor ammonue, Solution of Ammonia, is administered by some as 
a diaphoretic, under the same circumstances as carbonate of ammonia. 
The dose is "liv to ^Ixx, in sugared water, or properly diluted. 

Ammonia citras, Citrate of \ftmmonia, which is commonly prepared 
by saturating the ammonia of carbonate of ammonia with fresh lemon- 
juice, is occasionally used as a diaphoretic both in the still and effer- 
vescent state. 



6. EUPATO'RIUM .— THOR'OUGH V\ ORT. 

Eupatorium perfoliatum, Thoroughwort, Boneset, Sex. Syst. 

69 Syngenesia^qualis; 

Nat. Ord. Compo- 
sitee Corymbiferaa, is 
an indigenous plant, 
common in almost 
all parts of the Unit- 
ed States ; inhabiting 
moist places, and 
flowering from the 
middle of summer to 
the close of October. 
The tops and leaves 
are officinal in the 
Pharmacopoeia of the 
United States. 
No analysis has been 
made of it ; but its 
medical virtues, which 
appear from the taste 
to consist in part of 
bitter extractive, are 
communicated to wa- 
ter and to alcohol. 

The virtues of eu- 
patorium as a diapho- 
retic are esteemed by 
some to be very pow- 
erful, and to succeed 
Hence it has been given 




Enpatorium perfoliatnm. 

when other excitant diaphoretics have failed. 



318 SPECIAL DIAPHORETICS. 

freely in acute and chronic rheumatism. The tonic properties, which 
it possesses at the same time, render it especially adapted for cases in 
which a diaphoretic ,and tonic influence is demanded. In very large 
doses it may prove emetic. 

As a diaphoretic, it is rarely given in substance. The ordinary dose 
of the powder is from 9j to gss. The infusion is generally prescribed. 

INFU'SUM EUPATO'RII, INFUSION OF THOR'OUGHWORT. (Eupator. |j ; Jlq. 
bullient. Oj.) This should be taken warm and freely, the patient re- 
maining in bed. It has been very strongly recommended by Dr. Peebles, 
of Petersburg, Virginia, in influenza, — given so as to keep up a nau- 
V seant effect on the system. 

Eupato'rium Teucrifo'lium, Wild Horehound, — which grows in 
low wet places, is especially abundant in the Southern states, and 
flowers from August to November, — possesses similar virtues with E. 
Perfoliatum. The whole herb was formerly officinal in the secondary 
list of the Pharmacopoeia of the United States. 

7. SPIR'ITUS ^'THERIS NI'TRICI.— SPIRIT OF NITRIC ETHER. 

This preparation, whose general properties are given elsewhere (p. 
278) — has been described as possessing the ordinary excitant properties 
of the ethers and alcohol. It may, consequently, prove diaphoretic ; 
and be beneficial in fevers of the adynamic kind. It is not so easy to 
see how it can be refrigerant ; although it is so regarded by many. 
There is no single article in the catalogue of the Materia Medica, which 
is more frequently prescribed by the routinist in febrile cases in general. 
Fortunately, it is never given in large quantities, and, therefore, not 
much harm results ; yet it is difficult to see how it can be appropriate 
where the vascular action is excessive, as in our ordinary febrile and 
inflammatory affections. By many it is associated with the liquor am- 
moniae acetatis ; by others with antimonials, — the latter not being a very 
philosophical combination, as one of the diaphoretics is excitant, the 
other sedative. With more propriety it has been advised in combina- 
tion with a small quantity of compound spirit of ammonia, and pre- 
scribed in the low stage of fevers. Often, perhaps, — especially in the 
febrile affections of children, — it is prescribed in the dose of a few drops, 
without the practitioner having much, if any, confidence in its diapho- 
retic powers, but where it is necessary to do something. Its dose, as a 
diaphoretic, is f.Jss to f.3ij> in water. 

8. CAM'PHORA.— CAMPHOR. 

Camphor — whose general properties are described under Excitants 
— by virtue of its excitant powers is diaphoretic ; yet it is rarely given 
alone. Combined with antimonials, as tartrate of antimony and potassa, 
it is prescribed occasionally in fevers of the adynamic kind ; yet the 
combination seems scarcely to be philosophical, inasmuch as one article 
is diaphoretic by virtue of its excitant, the other of its sedative agency. 



GUAIACI LIGNUM. 



319 



It has been elsewhere shown, that in long protracted fevers of the ady- 
namic and ataxic kind, it is often associated with opium. 

The ordinary dose as an excitant diaphoretic is ten grains, given in 
the form of a pill or emulsion. Its officinal preparations are scarcely 
ever prescribed as diaphoretics. 



9. GUAI'ACUM.— GTJAI'AC. 

Both the wood of Guaicum officinale — Guai'aci Lignum and the con- 



Fig. 70. 




Guaiacum officinale. 
1. Corolla and stamens. 2. Seeds. 3. Fruit. 



crete juice — Guai'- 
aci Resi'na, Guaiac 
— are officinal in the 
Pharmacopoeias of 
Great Britain and 
this country. They 
have been long em- 
ployed in Europe, 
where they were 
introduced by the 
Spaniards soon after 
the discovery of the 
New World. 



Guaiacum officinale; 
Sex. Syst. Decan- 
dria Monogynia ; 
Nat. Ord. Zygophyllacese, (Lindley,) is a large tree indigenous in the 
West Indies, particularly in Saint Domingo and Jamaica. On the con- 
tinent of Europe, the bark is much used, and it appears to contain more 
of the virtues of the tree than the wood. 

1. GUAIACI LIGNUM, GUAIACUM WOOD, Lignum Vitae, is an extraordinarily 
hard and tough wood, which is used for making pestles, block-sheaves, 
&c. It is imported ixar logs or billets, consisting of a broad grayish-yel- 
low alburnum, and a dark greenish-brown or greenish-black duramen, 
the latter of which is the denser of the two. The specific gravity of the 
whole is 1.333 so that it sinks in water. Guaiac wood of the shops, 
Rasu'ra Guai'aci, consists of the turnings from the workshop of the 
turner, and is a mixture of both alburnum and duramen. It is almost 
devoid of smell, unless when rubbed, rasped or heated, when it has an 
aromatic odour. It excites a bitter, acrid biting taste on the palate. 
When analyzed by Trommsdorff, it was found to contain 26 per cent, 
of resin — probably the guaiac, to be described presently, — with a bitter 
piquant extractive matter, which was most abundant in the alburnum ; 
the resin abounding in the central wood or duramen. The central wood 
has generally been preferred, and the alburnum has even been directed 
to be discarded by some, under the idea that its activity is altogether 
dependent upon the resin it contains. This, however, as has been re- 
marked by a recent pharmacologist, Dr. Christison, is a mistake ; and 
even if we were not to accord with him, that the more acrid alburnum 



320 SPECIAL DIAPHORETICS. 

ought, perhaps, to be preferred, we might still object to the rejection of 
the acrid principle. 

Guaiacum yields its virtues to both alcohol and water, but not equally 
well to both. The resinous matter is, of course, not wholly imparted to 
the latter. Alcohol has been found to dissolve 21 per cent. ; boiling 
water 10 per cent, according to one experimenter ; 17 according to 
another ; — yet, the most favourite preparations of guaiacum wood have 
been at all times decoctions ; which would rather favour the idea, that 
the activity may be greatly resident in the acrid principle. 

Guaiacum wood is an excitant diaphoretic, less perhaps on account 
of the acrid extractive it contains than of the resin, which is nearly in- 
soluble in water. It is rarely, however, administered as a diaphoretic. 
It has been given in chronic rheumatism in the form of decoction ; and 
has frequently been prescribed — as will be seen elsewhere — as a eutro- 
phic, in diseases of the system of nutrition, — in scrofulous, syphilitic and 
syphiloid affections, for example. Where the active excitant properties 
of guaiacum are wanted, the resin is almost always directed. 

A simple decoction of guaiacum may be made by boiling an ounce of 
the shavings or turnings in a pint and a half of water down to a pint. 
To produce diaphoresis, this should be given warm, in the dose of four 
fluidounces repeated every five or six hours if necessary. 

Guaiacum wood is an ingredient in Decoctum Sarsaparillce composi- 
tum, and Syrupus Sarsaparillce compositus of the Pharmacopoeia of the 
United States. 

2. GUAI'ACI RESI'NA, GUAI'AC, or, as it has been erroneously called Gum 
guaiac, is an exudation from the tree, spontaneously, or by means of 
incisions. It is obtained, also, by taking billets of the wood, boring a 
hole lengthwise through them, and putting one end in the fire ; the 
other being so placed that the melted resin, which runs through the hole 
as the wood burns, may be received in a calabash. This appears to be 
the process usually followed ; but it is likewise obtained in small quan- 
tities by boiling chips or sawings of the wood in salt water, when the 
resin swims on the top, and may be skimmed off. The salt is added to 
xaise the boiling point of the water. 

Guaiac, as found in the shops, is usually in irregular lumps, often con- 
taining chips of wood and other impurities. These are of a brownish- 
red or brownish-yellow colour at the surface, when fresh ; but they 
become greenish on exposure to air. The fracture is brilliant and 
resinous. Specific gravity about 1.23. When rubbed, it has a slight 
balsamic odour, with little taste; but leaves a sense of heat and pun- 
gency in the mouth. The whole of the resin is soluble in alcohol; the 
impurities alone being left. Water dissolves about 9 per cent. ; and the 
solution has a sweetish taste. The soluble matter is probably extractive, 
which Mr. Brande found to exist in it in the proportion of 9 per cent. 
The resin, considered by some to be peculiar, and which has been 
called Guaiacin and Guaiacic acid, forms, according to the same ana- 
lyst, 91 per cent. Ether acts less energetically on guaiac than alcohol ; 
and the fixed and volatile oils scarcely at all. This last circumstance 
enables an adulteration which is sometimes practised on the continent 



MEZEREUM. 321 

of Europe, to be detected. The resin of the pine or colophony is coloured 
green,, and mixed with it ; and the adulteration is detected by the par- 
tial solubility of the suspected article in hot oil of turpentine, which 
dissolves the colophony, but does not act on the guaiac. It exhales, 
also, a terebinthinate odour when heated. 

Like the wood of guaiacum, the resin is possessed of excitant pro- 
perties ; and, when aided by warm drinks — the patient being kept in 
bed — it proves diaphoretic. It is generally, however, associated with 
nitrate of potassa, ipecacuanha and opium, or antimonials ; and is most 
frequently prescribed in acute rheumatism after the more active period 
has passed away ; and in chronic rheumatism. In such cases it is, at 
times, arbitrarily combined with sulphur. It has likewise been given, 
on account of its excitant properties, in chronic atonic gout. 

The dose of powdered guaiac is from gr. x. to 3ss, given in the form 
of pill or bolus. The London and Edinburgh Pharmacopoeias have a 
Mistura Guaiaci or Guaicum Mixture, which according to the former, 
is composed of Guaiac 3'iij ; Sugar |ss ; Mucilage of gum arabic 
f.^ss; Cinnamon water f.5xix. The guaiac is rubbed with the sugar ; 
then with the mucilage ; and to these, whilst rubbing, the cinnamon 
water is gradually added. The dose is f.^ss to f.^ij, two or three 
times a day. 

TMCTU'RA GUAIACI, TINCTURE OF GUAIAC. {Guaiac. pulv. fgss ; Alcohol. 
Oij.) This tincture is not unfrequently given in the rheumatic and gouty 
cases referred to above. When mixed with water, the guiacum is 
separated. It may be taken in this manner ; but the best plan is to mix 
the tincture with mucilage before the water is added ; and sweeten 
with sugar, as in the following form : — R. Tinct. guaiac. f.3vj ; Mucilag. 
acaci ee f.%ss ; Aouce cinnam., vel. Aquas pur., f.^ivss. — M. Dose, a 
fourth part, four times a day. The ordinary dose of the tincture of 
guaiac is f.3j to f.giij. 

TINCTU'RA GUAIACI AMMONIA'TA, AMMO'NIATED TINCTURE OF GUAIAC. 

(Guaiac. pulv. 5iv ; Spirit, ammonice aromat. Oiss.) In consequence 
of the addition of the aromatic spirit of ammonia, this tincture is, of 
course, more excitant than the preceding. It is applicable, however, 
to the same cases ; and requires the same admixtures as the simple tinc- 
ture. The dose is f.Jj to f.3ij- 

10. MEZE'REUM.— MEZE'REON. 

The mezereon of the shops is the bark of Daphne mezereum and 
Daphne gnidium; Sex. Syst. Octandria Monogynia ; Nat. Ord. 
Thymelacese, (Lindley.) The British colleges refer it entirely to 
Daphne mezereum, Common mezereum or Spurge Olive, a shrub 
which is common in shady woods throughout central and northern 
Europe, as well as in the northern parts of Asia ; and is generally re- 
garded to be indigenous in Great Britain. Dr. Christison, however, 
considers it a u , doubtful native," of that country. It is occasionally 
seen in the gardens of this country, being much admired for its beauti- 
ful fragrant pink flowers, and its splendid clustered scarlet berries. 

Vol. I.— 21 



322 



SPECIAL DIAPHORETICS. 



Fig. 71. 




1. Stamens. 



Dapbne mezereum. 
2. Pistil. 3. Part of berry and seed. 



There is a variety, how- 
ever, with white flowers, 
and with berries of a yel- 
low or orange colour. It 
flowers from February 
to April inclusive, ac- 
cording to the greater or 
less temperature of the 
climate. 

In England and Scot- 
land, the bark of the 
root is alone used ; in 
this country, the bark 
of the stem is recog- 
nized, which is import- 
ed from Germany. It 
appears to be immate- 
rial which is employed ; 
such, at least, would 
seem to be the opinion of 
the framersoftheDublin 
and United States Pharmacopoeias. Others, however, consider the root 
bark to be more active. It is commonly collected in the spring, from 
the root, where the root bark is employed ; or from the bark of the stem 
and larger branches — as in Germany — when it is folded into small 
bundles, and dried for medical use. As we meet with it in the shops, it 
is in strips of greater or less length, folded in small bundles. It is 
tough, pliable and fibrous, of a brown colour externally, and white and 
cottony within. Its taste is sweetish at first, but this is soon followed 
by great acridity. It has no smell when dried ; but when fresh the 
odour is faint and unpleasant. 

Mezereon yields its virtues to water. These seem to be referable to 
an acrid resin, which there is some reason to suppose is a compound of 
an acrid, vesicating, fixed oil, and another substance, and which is made 
soluble in water by means of other constituents of the bark. All the 
parts of mezereon are highly acrid, so that — as elsewhere shown— when 
applied to the skin, it excites irritation and vesication. When taken in- 
ternally, it is therefore, powerfully excitant ; and in large doses, an acrid 
poison. 

Like guaiacum wood, it has enjoyed reputation as a eutrophic of al- 
terative in the treatment of syphilitic and syphiloid diseases ; and in 
chronic cutaneous affections, and morbid states of the system of nutrition 
in general. Its virtues in these relations are, however, treated of in 
another place. Like guaiacum wood, again, it has been given in 
rheumatism and gout as an excitant diaphoretic, but it is not much em- 
ployed. A simple decoction of mezereon is officinal in the Edinburgh 
and Dublin Pharmacopoeias. It is prepared of mezereon bark, in chips, 
3ij ; liquorice root, bruised, |ss ; water Oij, boiled down to a pint and 
a half. The dose of this in chronic rheumatism is f.iiv to f.iviij, two 
or three times a day. 



MELISSA. 323 

Mezereon is an ingredient in Decoctum Sarsaparillce compositum of 
the Pharmacopoeia of the United States. 

11. SASSAFRAS RADI'CIS CORTEX.— BARK OF SAS'SAFRAS ROOT. 

This drug — as elsewhere shown — is excitant by virtue of its essential 
oil; and, like other excitants, may — under certain circumstances — 
prove diaphoretic. Dr. Wood, of Philadelphia, remarks, that "its pos- 
session of any peculiar tendency to the skin, independently of its more 
excitant property, is quite doubtful." This would apply perhaps to all 
excitant diaphoretics, which probably act — as the author has endeavoured 
to show — in all cases indirectly. 

When taken in the form of hot infusion or tea, aided by the warmth 
of bed and warm drinks, this drug certainly proves diaphoretic, and 
might therefore, be given, with advantage, in incipient catarrhs, and in 
slight local inflammations. It has, likewise, been prescribed in chronic 
rheumatism ; and as will be elsewhere seen— has formed part of diet- 
drinks administered in syphilitic and other vices of the system of nutrition. 
It is an ingredient in Decoctum Sarsaparillce compositum of the Phar- 
macopoeia of the United States ; although its volatile oil cannot fail to 
be driven off during the boiling. 

O'LEUI SAS'SAFRAS, OIL OF SAS'SAFRAS, is employed in the same cases as 
sassafras itself; and is an ingredient in Syrupus Sarsaparilla compositus 
of the Pharmacopoeia. Its dose is from m,ij to ^lx on sugar, or in some 
warm fluid. 

12. MELIS'SA.— BALM. 

The leaves of Melissa officinalis or Common Balm; Sex. Syst. 
Didynamia Gymnospermia ; Nat. Ord. Labiatae — are officinal in the 
secondary list of the Pharmacopoeia of the United States. The plant is 
a native of the south of France ; but has been introduced into this 
country, where it is cultivated for use in the gardens. The flowers ap- 
pear in July, prior to which the plant should be gathered. 

Balm has an aromatic bitter taste, and a strong peculiar odour, which 
is preserved by the dried plant, provided the desiccation be accom- 
plished quickly; but is lost by time. On analysis, it yields volatile oil, 
which resembles in smell oil of lemons ; — resin ; bitter extractive matter ; 
gum ; tannic acid, and woody fibre. The volatile oil is not in great 
quantity. The leaves yield their virtues to hot water. 

Infusion of Balm, Balm Tea, is stimulant by virtue of its essential 
oil ; but as this is only in quantity sufficient to afford an agreeable fla- 
vour to the infusion, it cannot have much remedial agency. In domestic 
practice, it has been esteemed an excitant diaphoretic, when given hot ; 
but the effects are probably referable to the hot water. The author has 
often seen it exhibited ; and is disposed to arrive at this conclusion. It 
may be given in catarrhal and other affections in which a gentle excitant 
Influence on the skin is considered to be indicated. 

13. ASCLE'PIAS TUBERO'SA — ByT'TERFLY WEED. 

The root of Butterfly weed, Pleurisy Root, is in the secondary list of 
the Pharmacopoeia of the United States. It belongs in the Sex. Syst., 



324 SPECIAL DIAPHORETICS. 

to Pentandria Digynia ; and is in the Nat. Ord. Asclepiadeae. This 
species of Asclepias flourishes in every part of the United States, and 
flowers in June and July, — the flowers being of a beautiful reddish 
orange colour. It is especially abundant in the Southern states. Dr. 
Lockwood advises, that the root should be collected about the first of 
October, be cut in transverse slices, dried in the shade, and as soon as 
sufficiently dried, pulverized and bottled. 

The root, as seen in the shops, is large and irregularly tuberous ; 
of a brown colour externally, and white and striated within. In its fresh 
state, it has a nauseous subacrid taste. Its virtues are imparted to boil- 
ing water. 

Asclepias tuberosa belongs, doubtless, to the class of excitant dia- 
phoretics ; and, in large doses, is said to be cathartic. It has been 
prescribed in catarrh, and in inflammatory affections of the chest in 
general, especially after blood-letting ; and, in consequence of its fancied 
efficacy in pleurisy especially, has received one of its appellations. 

The dose of the powdered root is gr. xx to 5i> taken three or four 
times a day ; but this is not the best form as a diaphoretic. The decoc- 
tion or infusion is generally employed for this purpose, in the proportion 
of one ounce of the root to a quart of water ; — the dose being a tea- 
cupful every three or four hours, taken warm, and the patient being kept 
in bed, and warm diluents allowed. Dr. Lockwood says, that the warm 
decoction acts with as much certainty as a diaphoretic, as jalap does 
as a cathartic. (?) 

14. XANTHOX'YLUM.— prickly ash. 

Xanthoxylum is the bark of Xanthoxylum Fraxineum ; Sex. Syst. 
Dioecia Pentandria; Nat. Ord. Terebinthacese, — Xanthoxyleae, (Lind- 
ley,) a native of the United States, excepting of the southern portion, 
growing in woods and in moist shady places ; and flowering in April 
and May. 

The bark, as met with in the shops, is in quilled pieces with an ash- 
coloured epidermis ; that of the small branches having strong prickles. 
It is very light and brittle ; nearly without smell, and of a taste sweet- 
ish at first, and slightly aromatic, and afterwards bitterish and acrid. Its 
virtues are communicated in part to boiling water. On analysis by Mr. 
Staples it was found to contain volatile oil, a greenish fixed oil, and 
resin, as its chief constituents. 

Xanthoxylum belongs obviously to the class of excitant diaphoretics, 
and is considered to resemble, in its action, raezereon and guaiac. It 
has been administered in similar cases, and is said by Dr. Bigelow, of 
Boston, to enjoy considerable reputation in chronic rheumatism. The 
dose of the powder is gr. x. to 3ss, given three or four times a day. It 
is sometimes directed in decoction, — an ounce of the drug being boiled 
in three pints of water to two ; a pint of this is taken in divided doses 
during the day. Boiling can scarcely fail, however, to dispel some 
of its active constituents ; and therefore cannot be a good form of 
preparation. 



ARALIA SPINOSA. 



325 



Fig. 72. 



Fig. 73. 




Arum trlphyllum. 



Xanthoxylum fraxineum. 



Xanthoxylum is in the secondary list of the Pharmacopoeia of the 
United States. 



Besides the excitant diaphoretics already described, the Pharma- 
copoeia of the United States has the following in its secondary list. 

15. Ara'lia Spino'sa, Angelica Tree Bark. Aralia Spinosa, An- 
gelica Tree, Toothache Tree, or Prickly Ash ; Sex. Syst. Pentandna 
Pentagynia; Nat. Ord. Araliaceas, is an indigenous shrub, which 
grows chiefly in the Southern and Western states, and is cultivated in 
the gardens to the north as an ornamental plant. It flowers in August 
and September. The bark is generally given in decoction, {Aral, spinos. 
3j; Jlqua Oiss. Boil to a pint. Dose f.giss to, fjij, three or four 
times a day, in chronic rheumatic cases.) 

16. Arum, Dragon Root, Indian Turnip, is the cormus of Arum 
Triphyllum, Dragon Root, Indian Turnip or Wake Robin; Sex. Syst. 
Moncecia Polyandria ; Nat. Ord. AroideaB,— Aracese, (Lindley.) Ine 
plant is indigenous and common in the United States ; and, like every 



326 



SPECIAL DIAPHORETICS. 




Fig. 75. 



species of arum, contains an acrid principle, when fresh, which can be 
driven off by heat, and is not imparted to water or alcohol, the ordinary 
pharmaceutical menstrua. By drying, the principle is lost, and the root 
becomes inert, containing a large quantity of starch, which can be sepa- 
rated from it and taken as an aliment. It is sometimes used, when 
fresh, as a diaphoretic and expectorant. The recently dried root is 
usually given, but it has not much efficacy. The dose is ten grains. 

17. Car'thamus, Dyers' Saffron. The flowers of Carthamus tincto- 
Fig. 74. rius, Dyers' Saffron, Bastard Saffron or Safflower ; 

Sex. Syst. Syngenesia iEqualis ; Nat. Ord. Compo- 
sitse Cynarocephalee — a plant, which is indigenous in 
Egypt and the Levant, but is cultivated in Europe 
and in this country, where it bears the name of Ame- 
rican Saffron — are sometimes administered in warm 
infusion, (Cartham. ^ss.Aqux Oj.,) as a diaphoretic, 
in domestic practice, to favour the eruption of the 
'major exanthemata. They are rarely prescribed by 
, the physician ; and the same may be said of 

18. Crocus, Saffron ; the stigmas of Crocus sativus, 
carthamus tinctorius. Autumnal Crocus ; Sex. Syst. Triandria Monogynia ; 
Nat. Ord. Iridacese ; — a native of Asia Minor, and Eastern Europe ; 

but cultivated in various parts of the 
world. Saffron is in the primary list of 
the Pharmacopoeia of the United States, 
but only because it enters as a colouring 
agent into various preparations ; in some 
of which it is retained as a relic of anti- 
quity, not because of any valuable re- 
medial virtues. In domestic practice, it 
is still given in the same cases as cartha- 
mus, in the form of Saffron Tea. Its 
nominal dose is gr. x. to 3ss ; but it is 
almost inert. 

It enters into Pilulce Aloes et Myrrha, 
Tinctura Aloes et Myrrhce; Tinctura 
Cinchona, Composita, and Tinctura Rhei 
et Senna, of the Pharmacopoeia of the 
United States. 

19. Sambu'cus, Elder Flowers. The 

flowers of Sambucus Canadensis or 

Common Elder; Sex. Syst. Pentan- 

dria Trigynia; Nat. Ord. Caprifolia- 

c sativus. p eae — a shrub, which is very common 

1. Petal and Stamen. 2. Style and Stigmas. IB the United States, flowering from 

... . . May to July— are sometimes used as a 

diaphoretic in the form of infusion. They contain a small quantity of 
volatile oil, which may be obtained by distillation with water,— con- 




WARM VAPOUR BATH. 327 

stituting Jiqua Sambuci or Elder Flower Water of the British Pharma- 
copoeias, which is used to flavour mixtures and emulsions. 

III. Topical Diaphoretics. 

20. CALOR'IC. 

Along with the internal agents already described, caloric, in various 
forms of baths, is often employed as a topical diaphoretic. Of the 
effects of baths on the animal economy in health, mention has been 
made elsewhere. (See the author's Human Health, p. 358; Philad. 
1844.) It remains to speak of them here as therapeutical agents of the 
diaphoretic class. 

a. WARM AIR BATH. 

Air, when heated to from 85° to 100° of Fahrenheit's scale, and 
placed in contact with the cutaneous surface, is a gentle excitant to the 
secretory apparatus of the skin, and occasions copious perspiration. 
When heated to a greater degree, it forms the hot air bath, which, in 
place of inducing diaphoresis, may cause a degree of excitement that may 
arrest the secretion. Warm air has been applied in various ways ; 
either by raising the bed-clothes from the body by means of a wicker 
cradle, and then allowing the tube from a lamp to pass under the bed- 
clothes, or by burning alcohol in a cup or saucer under the same ;— in 
either case, the patient's head and neck being outside the bed-clothes. 
It might be applied also by means of one of the ordinary fumigating 
apparatuses, in which vapours are made to come in contact with the 
body; or by heating the air of an apartment by means of a cockle or 
some appropriate stove. Dry heated air is not, however, inhaled with 
entire impunity in all cases. It is greedy of moisture ; and, where the 
lungs are diseased, may occasion much distress in respiration. At the 
temperature of 85° to 90°, applied to the surface in either of the first 
two modes, it is said by Dr. A. T. Thomson to be not stimulating,— to 
have a soothing effect on the nervous system,— and to be " more cer- 
tainly productive of sweating than either the warm water bath or the 
vapour bath." A bath of this kind has been found useful in chronic 
rheumatism, and in various neuralgic affections of deep-seated parts ; 
stiffness of the joints, &c. It is said, also, to have exerted a beneficial 
agency in cutaneous affections, especially of the squamous kind. Where 
the blood has receded from the surface, as in cases of congestive fever, 
or in spasmodic cholera, the bath is rendered more excitant by elevating 
the temperature. It then becomes a true excitant, and, accordingly, is 
treated of under another head. (See Excitants.) 

b. WARM VAPOUR BATH. 

The warm vapour bath holds a medium place between the last and 
the warm water bath. The vapoury medium is a better conductor of 
heat than air, and worse than water ; hence its temperature, to P r0 ^ u ^ e 
analogous effects, must be higher than that of the warm water bath. 
The vapour bath differs, too, according to the mode in which it is ap- 



328 SPECIAL DIAPHORETICS. 

plied. In the case of the Russian vapour bath, the whole body is ex- 
posed to the vapour, and it is of course inhaled into the lungs. In other 
cases, the vapour is made to come in contact with the whole of the 
body, except the head, — none passing into the lungs. In another work, 
already referred to, (Human Health, p. 47,) the author has described 
the arrangement and effects of the Russian bath, which is used mainly 
as a hygienic agent. 

Owing to these differences between the vapour bath and the warm 
water bath, it has been laid down, that the temperature of the former 
should always exceed that of the latter. If, however, the whole body 
be immersed in vapour, so that it is inhaled, it is recommended, that 
the temperature should be a little less than if the body alone were ex- 
posed to it ; as the inhalation of vapour arrests the cooling process of 
evaporation from the lungs. 

The following is given on excellent authority, — that of Dr. Forbes,— 
as a comparative view of the heating powers of water, and of vapour, 
according as the latter is breathed or not. 



Tepid Bath, 
Warm Bath, 
Hot Bath. 


WATER. 


VAPOUR. 


85°— 92° 
92°— 98° 
98°— 106° 


Not breathed. 


Breathed. 


96°— 106° 
106°— 120° 
120°— 160° 


90°— 100° 
100°— 110° 
110°— 130° 



In the work already cited, and in another part of the present, the 
author has stated the effects of the hot vapour bath to be — like those of 
the hot water bath — powerfully excitant, and therefore, not properly 
falling under consideration here. Those of the warm vapour bath are 
moderately excitant, but powerfully diaphoretic ; producing a general 
equalizing influence, followed by a feeling of languor, and by somno- 
lency. Hence, it may be used with marked advantage in slight inflam- 
matory affections, especially in those of the gastro-pulmonary mucous 
membrane. In such cases, it would obviously be better, that the bath 
should be so administered, that air loaded with vapour should be re- 
ceived into the air-passages. It may also be of service in dry chronic 
cutaneous eruptions, and in rheumatic affections ; although in these 
last the hot vapour bath proves more serviceable. 

For therapeutical purposes, the patient may be covered with an oil 
silk garment, which ties about the neck, and is made to fall at a dis- 
tance around him. A tube, connected with a kettle of boiling water, 
placed over a spirit lamp, may then be passed under the oil cloth at 
such a distance from the patient's body as to prevent his being scalded; 
and in this way warm vapour may be made to come in contact with it. 
In certain of the public and private bathing establishments an appro- 
priate apparatus is provided for taking a steam bath at any temperature. 

Sometimes the vapour is medicated by impregnating it with aromatic 
oils from plants boiled in the water, or from some volatile oil being 
added to it in the vessel ; but although these may somewhat augment 
the excitant action of the vapour, there is no great reason to believe 



WARM WATER BATHS. 329 

that much remedial agency has been exerted by them. Of other va- 
porous agents that may be added, mention is made under those agents. 

C. WARM WATER BATH. 

The tepid bath, — the temperature of which may be ranged between 
75° and 90° of Fahrenheit, may be regarded as refrigerant rather than 
diaphoretic ; and, therefore, its therapeutical effects fall more pro- 
perly under Refrigerants, and are considered elsewhere. The or- 
dinary temperature of the warm bath is between 90° or 92° and 96° or 
98°. Even when as low as 90°, and lower, a pleasurable feeling of 
warmth is experienced on immersion, because the temperature of the 
air is generally below this point, and, accordingly, the body is com- 
monly parting with more caloric. 

Although when first applied, the effect may be to gently excite the 
secretory organs of the skin, the great influence is the equalization 
exerted by it, owing to the blood being solicited every where to the 
surface. Under this agency, inflammatory concentrations are broken in 
upon ; and hence it becomes one of the most beneficial remedies in minor 
degrees of internal hyperaemia especially ; and, likewise, in cases where 
the inflammatory mischief is to a greater amount. Its main action is, 
indeed, sedative, — that is, the gentle excitation first produced by it in 
the cutaneous system is so speedily followed by sedation, that the latter 
effect is predominant. Accordingly, although, on immersion, the pulse 
may become more frequent, and the respiration somewhat accelerated, 
languor and evidences of diminished action soon succeed, with impair- 
ment of muscular power, a tendency to faintness, and somnolency. 
Hence, it is used by the surgeon to relax constricted parts, as in cases 
of luxations, and hernia, and of the passage of urinary or biliary concre- 
tions. 

In almost all acute phlegmasia?, after more powerful sedatives have 
been employed, the warm bath is found of decided service, on the principle 
just mentioned ; hence, in thoracic and abdominal inflammations, more 
especially when occurring in children, it is much used, and there is no 
remedy more soothing. In eruptive fevers, particularly where the erup- 
tion does not appear kindly, its beneficial agency is often marked ; and 
it is especially applicable to cases where the temperature of the surface 
is depressed, and the circulatory action feeble. In such cases, it ought 
to approach the hot bath in temperature ; and many cases absolutely re- 
quire the strong excitant influence of water heated above the tempera- 
ture of the body. In chronic inflammations, the properly directed use 
of the warm bath is not less serviceable. In dyspepsia, too, it exerts a 
salutary effect, especially when conjoined with friction on the surface ; 
and in various spasmodic diseases, — as convulsions, particularly of 
children, — its soothing and equalizing influence is admitted by all. 
There is, however, so much inconvenience in its employment in the 
last case, when an infant is suddenly taken with convulsions, that, by 
some, as by Dr. Dewees, it was abandoned, and friction substituted. 

Like the warm vapour bath, it may be beneficial in various dry cuta- 
neous diseases, and in rheumatic affections ; and there are cases of 



330 



SPECIAL DIAPHORETICS. 



Fie. 76. 




Warm-Bath. 



amenorrhcea and of dysmenorrhcea,— in the latter especially, when 
accompanied by a membranous secretion, the result of an excited 
action of the secretory vessels of the lining membrane of the uterus, — 
in which it is of decided service. 

Dr. A. T. Thomson has invented an apparatus, which he regards as 
the simplest warm bath. It consists of a hammock a, of India rubber 
cloth, which is extended upon two long poles b 6, passed through 
a broad seam on each side of the hammock, and kept asunder by 

the cross pieces, c, 
which are attached 
to the poles by the 
thumb screws d d 
d. At one end of 
the hammock is an 
air pillow, which 
can be readily 
blown up ; and be- 
low it is a flexible 
tubef, made of the 
same material as 
the hammock, by which any water it may contain can be readily drawn 
off. When the poles are fixed, as in the marginal figure, and the open 
end of the flexible tube is twisted round one of the thumb screws, the 
bath is ready to receive the water. It may be supported upon two 
chairs, or upon folding tressels e e. The advantage of this bath, accord- 
ing to Dr. Thomson, is, that it requires a very small quantity of water 
compared with that demanded for other baths, and that when the ba- 
thing is completed, the poles and the folding tressels can be placed aside 
in a small closet, or in the corner of a dressing room, and the hammock, 
when dried, be put into a drawer. 

Partial warm baths are much employed, where the desire is to 
affect particular portions of the cutaneous surface, and through them, 
the whole system, or organs in the vicinity of those to which they are 
applied. Thus, the warm Hip-bath is employed, par- 
ticularly in inflammatory and other affections of the 
abdominal and pelvic viscera; and the warm foot- 
bath, in colds, and with the view of restoring the 
menstrual secretion when arrested. The influence 
of the warmth is soon extended to other parts of the 
capillary system, and diaphoresis frequently results — 
especially if it be favoured by the warmth of the 
bed, and the use of warm diluent drinks. When 
the object is to exert a revellent influence in these 
cases, the temparature of the water is elevated, and 
salt and mustard are at times mixed with it. The 
arm-bath and hand-bath are rarely used except as mere topical 
agents. 

In the use of the warm bath, there is rarely any shock experienced ; — 
in other words, no powerful impression is made by it on the nervous 



Fig. 77. 




Hip-Bath. 




Foot-Bath. 



THE WET SHEET. 331 

system ; hence, no apprehension need be enter- 
tained of its producing injurious consequences g ' _; 
except in highly impressible persons. In such, 
or where there is a tendency to encephalic affec- 
tions, the temperature must be carefully regulated 
so that it be not too excitant. Both the general 
and topical bath are likewise considered to be 
unadvisable" in pregnancy, and whilst the cata- 
menia are flowing; but the injurious effects, in 
such cases, have doubtless been exaggerated. 

The time, during which the individual should remain in the bath, 
must be determined by the nature of the case. In acute diseases, a 
few minutes may be sufficient ; but where it is desirable to relax either 
the skin, as in cutaneous diseases, or the powers of the system, the 
patient may continue in it for a considerable time. Where the affection 
is chronic, the bath may be taken two or three hours after a meal, so 
that digestion may not be interfered with. When the patient leaves 
the bath, friction with warm flannels may be used in chronic cases. In 
acute cases, he may be removed from it, and be placed in blankets. 

Warm fomentations and Poultices act as topical baths, by virtue 
of their warmth and moisture. They relax the parts with which they 
come in contact, and, as in the case of pediluvia, the soothing topical 
influence they exert is extended elsewhere, — so that a sedative influ- 
ence may be produced on the system generally, and on the vessels that 
may be affected with any internal hyperemia especially. 

Injections of warm water thrown into the rectum or vagina, in 
cases of diseases of the uterus, peritoneum, or the upper portions of the 
intestines, act in the same manner as warm fomentations. 

Perhaps there is no better mode of exciting diaphoresis where mischief 
is not apprehended from the nervous impression made on its first appli- 
cation than 

d. the wet sheet, 

% 
as employed by the hydropathist, whose system of medication is referred 
to in another part of this work. The L e i n t u c h or sheet wetted in cold 
water is wrapped round the body ; which is then enveloped in blankets, 
and the patient kept in this condition until copious diaphoresis occurs. 
It is a powerful revellent agency and may be employed to break in upon 
morbid catenations. In this way, in the opinion of the author, it acts in 
the various neuropathic diseases in which it has been serviceable. In 
chronic gout and rheumatism, the good effects have by some been ascribed 
to the profuse diaphoresis occasioning an evacuation of the materies 
morbi supposed to be present in the blood ; but this is questionable, 
for, as has been before remarked, certain of the remedies that have 



332 NARCOTICS. 

proved most beneficial in those diseases have not appeared to increase 
the cutaneous secretion. 

e. FRICTION. 

Friction of the body, with dry flannels or with the flesh-brush, excites 
the action of the secretory organs of the cutaneous surface, and in 
moderation tends to the production of diaphoresis. It is rarely, how- 
ever, employed with this view, except as an adjunct to the warm bath; 
and even then is more used hygienically than therapeutically. Friction 
is frequently employed topically to modify nutrition ; but its considera- 
tion in that light will fall under the head of Eutrophics. 



SECTION IV. 

AGENTS THAT AFFECT PROMINENTLY THE NERVOUS SYSTEM. 



I. NAKCOT'ICS. 

Synon. Obstupefacientia, Slupefacientia. 

Definition of Narcotics — May be used as excitants, and as sedatives — Their action eluci- 
dated by that of Opium — May act locally as well as generally — Mental narcotics — 
Anaesthetics — Therapeutical application of narcotics — In febrile diseases — In the phleg- 
masia, &c. — Special narcotics. 

Narcotics greatly resemble, in their action — when administered in 
appropriate doses — the class of sedatives. They differ from them, 
however, in several respects. Whilst the action of sedatives is not 
preceded by any degree of excitation, that of narcotics is. In minute 
doses, again, narcotics may produce none of the effects that characterize 
them when given in large doses. Their agency may be altogether 
excitant ; and, with th« view of obtaining the modification in the 
organic actions, which such agency is capable of exerting, they are 
occasionally exhibited in small quantity. 

When given to the extent of inducing their peculiar action, they may 
be defined — " agjlnts, which first excite and then diminish nervous 
action, and, in appropriate doses, stupefy." The power of stupefying 
must be esteemed one of their main characteristics. 

Although the above definition may apply generally to their operation, 
when administered in a dose proper to produce a narcotic influence, it 
is obvious, from what has been said, that it is not wholly applicable, 
when they are given as mere excitants : in such case, they may not 
" diminish nervous action, and stupefy." They can then be regarded 
as excitants only ; but, in adequate doses, the latter part of the defini- 
tion is appropriate ; and the effects mentioned must be regarded as the 
most essential consequents on their employment. Even when they are 
administered in a full dose, some degree of excitation is first perceptible ; 
the functions of circulation, innervation, and secretion become more or 



NARCOTICS. 333 

less modified ; the pulse beats more rapidly, and forcibly ; the skin is 
hotter and drier than natural ; the nervous system exhibits greater im- 
pressibility ; and the mouth and fauces are dry, or their ordinary secre- 
tions are more tenacious than natural. But these evidences of excite- 
ment soon pass off— more rapidly in proportion to the size of the dose, — 
and a train of phenomena indicating sedation follows those of excite- 
ment ; the respiration becomes slower ; the skin moist; the pulse reduced 
to the natural standard, or below it; the impressibility of the nervous 
system is obtunded ; the tongue becomes moist ; and all the symptoms 
exhibit that a sedative and soothing agency has been exerted. Perhaps, in 
every case, however large the dose of the narcotic may have been, some 
degree of excitement might be perceived as a precursor of the sedation, 
were due attention paid ; but the sedative effect of a very large amount 
of any of the narcotics supervenes so rapidly on the stimulant, that the 
attention of the practitioner is scarcely directed to the latter operation — 
especially as it is not the one for the production of which he prescribed it. 

The marked difference between a stimulant and a sedative dose of 
the same agent can be understood from the cases, so often related in 
the newspapers, of persons, who, for wagers, have swallowed, at once, 
a large draught of some alcoholic liquor. The sedative effects of this 
powerful excitant — excitant, that is, in a smaller dose — are so speedily 
exerted, that a stop may be put to all the functions, without there being 
any marked symptoms of previous hurry in the organic actions. 

When a -narcotic is taken, the first effects occur in the nerves dis- 
tributed to the lining membrane of the stomach. These are rendered 
less impressible, and the obtunding influence is soon extended to the 
great nervous centres, which are affected like the nerves with which the 
narcotic first comes in contact. In this manner, the function of inner- 
vation generally has its activity diminished ; and, therefore — directly as 
well as indirectly — the gastric functions may be impaired. If the nar- 
cotic be taken before eating, and when a marked desire for food is pre- 
sent, the appetite may be diminished or extinguished, under the new 
condition of innervation. If food have been received into the stomach, 
chymification may, for like reasons, be retarded ; and the whole of the 
digestive operations — chymification, chylification and defecation — may 
exhibit torpor. It can thus be comprehended, that the use of a narcotic 
may be followed by constipation ; and that it may be well adapted for 
diarrhoea, where an indirect astringent agency appears to be indicated. 
The precise modus operandi of the narcotic may, in these cases, vary 
with the dose : where it is large, the whole function of innervation may 
be blunted ; and not only the secretions, but the peristole of the intes- 
tines be diminished ; whilst if the dose be smaller, the effect may be 
mainly exerted upon the nerves distributed to the gastric apparatus, 
without the rest of the nervous system materially participating. In 
cases of diarrhoea, opium, like every therapeutical agent, has a relative 
action ; and the same may be said of its employment in other morbid 
conditions. If irritation or inflammation exist in any portion of the ali- 
mentary canal, such irritation or inflammation maybe allayed by a seda- 
tive dose of a narcotic ; and, in this way, the pathological condition 
being removed, its symptom — the increased number and morbid charac- 



334 NARCOTICS. 

ter of the evacuations — may cease. A curious phenomenon, observed 
by M. Poiseuille, and confirmed by M. Bacchetti, — has been referred 
to before, — namely, the influence exerted by muriate of morphia when 
a saline solution, to which that substance has been added, is placed on 
one side of an animal membrane, and serum of the blood on the other. 
The endosmose, which previously took place from the serum to the 
saline solution, is considerably weakened after the addition of the 
muriate, and ultimately the direction of the current is reversed. "How 
can we" — says M. Matteucci — " make an entire abstraction of this fact 
in the explanation of the action of morphia, and of the preparations of 
opium in diarrhoea, as well as of the constipation which they produce?" 

It has been a very common remark, that opium is not well adapted 
for cases of pneumonia, bronchitis, &c, because it " diminishes the 
secretions," but this appears to be a questionable method of explaining 
its action. The suppression of secretions is not a morbid condition. 
It is only the symptom of such a condition; and when we state, that 
the indication is ' to restore the secretions ,' if the expression have any 
meaning at all, it can only convey the idea, that the morbid condition, 
which occasions their suppression, must be removed. Now, we know, 
that the first consequence of the inflammation of a mucous membrane 
is a diminution of its wonted secretion ; and that after the inflammation 
has persisted for a time, an increase of the secretion takes place ; but it 
is no longer of a healthy character. It is a secretion accomplished by 
vessels labouring under inflammatory excitement. 

Two opposite effects, then, on the secretory function are produced 
by different stages of inflammation. Yet, the indication, in both cases, 
must obviously be alike. It must be, to remove the morbid condition, 
of which these effects are symptomatic. A narcotic we know to be, 
in appropriate doses, a sedative ; — that .is, it is capable of diminishing 
the force of the circulation, and the energy of innervation. It is, there- 
fore, well adapted for acting as a contra-stimulant, and for thus allaying 
inflammatory excitement. A knowledge of its properties would sug- 
gest to us the propriety of its employment in the diseased state of mu- 
cous membrane instanced above ; and experience ought to show, as it 
does daily, that in one of the conditions assumed — in the early period 
of mucous inflammation — it will restore the secretions ; and, in the 
other, where the mucous secretions have become profuse and morbid, 
it will diminish them, — by diminishing the inflammation that occasioned 
them. 

It is obviously, therefore, incorrect to lay down the broad law, that 
4 opium diminishes the secretions? and that its use is improper whenever 
the indication is to ' restore the secretions? Such an indication ought 
never to be imagined. It is unmeaning, and can only have been sug- 
gested in the ignorance of true pathology ; and the author is happy to 
find, that a modern writer on therapeutics — Dr. Spillan — expresses his 
entire accordance with these sentiments, as expressed in the first edition 
of this work. In cases of pneumonia, where the expectoration has 
been free, a diminution of the sputa has seemed to supervene on the 
administration of narcotics ; but this has been owing to the agent not 
having been administered in a dose adapted to the morbid condition of 



NARCOTICS. 335 

the pulmonary organs. Where opium is given in a small 'dose — as is 
too often the case — it will as surely add to the inflammation as any 
other excitant ; and if we add to the inflammation, we may arrest the 
secretion altogether, by bringing back that condition of tissue, which 
existed at the onset of the inflammation ; but if, in this very case, a full 
sedative dose were administered, none of the evils might be found to 
follow. The sedative would allay the excited organic actions, and if 
the secretion were diminished — as it probably would be — it would be 
a salutury diminution, because arising from lessened inflammatory ex- 
citement in the lining membrane of the bronchial tubes, or in the tissues 
in their vicinity. 

Another example may be taken, in which the secretions and excre- 
tions are facilitated by narcotics. It has been already remarked, that 
opium is administered in cases w 7 here there is an undue number of alvine 
evacuations, with the view of exerting a constipating effect. But it is 
no less administered where constipation is dependent upon certain mor- 
bid states. When sero-enteritis or inflammation of the peritoneal coat 
of the intestines exists, constipation is a common symptom ; and, on the 
other hand, if the inflammation be seated in the mucous coat, diarrhcea 
is as common. Why this difference should exist is owing to the inflam- 
matory condition of the follicles, and of the mucous membrane gen- 
erally, being accompanied, after the disease has continued for a short 
time by augmented secretion. It might seem, however, that as the 
peritoneal coat so closely invests the muscular, the latter ought to be 
thrown into inordinate contraction, and an increase be occasioned in the 
number of the evacuations from this cause. \ Such contraction does 
exist, but the requisite irritation in the lining membrane is wanting to 
induce diarrhcea ; the contraction of the fibres has more of the character 
of spasm ; and a derivative effect is perhaps exerted, owing to the con- 
centration of the excited' organic actions in the peritoneal coat diminish- 
ing the amount of secretion from the mucous coat : in this manner, 
constipation comes to be one of the phenomena of peritoneal enteritis. 
In such a case, opium, judiciously administered, exerts its sedative 
agency ; diminishes the inflammatory action in the peritoneal coat, and 
resolves the spasm in the muscular coat ; so that the causes of the 
constipation being removed it ceases ; and we thus have a laxative, or 
cathartic effect, induced by remedies, which, in other morbid conditions, 
are well adapted for producing opposite results. 

These are cases, which exhibit the value of the possession of sound 
pathological and therapeutical knowledge. We discover empirically 
the property of the drug, and having accurately appreciated the agency 
it is capable of exerting, we can say h priori what will be the morbid 
state, in which the greatest benefit may be reaped from its employment. 
Accordingly, as the author has remarked in an early part of this volume, 
analogy has led to the employment of the invaluable agent, opium, in 
cases, in which some years ago it would never have been ventured upon. 
Some pathologists have considered it best adapted for phlegmasia of 
the peritoneum — both of the membrane proper, and its extensions over 
the different viscera. This was the view of the indefatigable investi- 
gator of the diseased conditions of the animal economy— Dr. Arm- 






336 NARCOTICS. 

strong. In these phlegmasia?, he conceived it to be perhaps the most 
efficient therapeutical agent that we possess ; and, although he esteemed 
it best to associate it with bloodletting, and to repeat both remedies ac- 
cording to the urgency of the case, he was disposed to think, that if he 
himself were labouring under peritoneal enteritis, and were told, that 
he must rest his hopes upon the lancet singly, or upon opium singly, he 
should be disposed to select the latter. 

What Dr. Armstrong said of the use of opium in these cases has been 
extended to similar morbid conditions in other serous tissues and else- 
where ; and many advantages have accrued from its employment, in 
some form of preparation, in cases, in which, at one time, its use was 
unknown, or considered inappropriate. 

In a work on Therapeutics by Dr. Chapman, of Philadelphia, we have 
the following remark. — " Concerning the operation of opium, medical 
sentiment continues to be divided, though the preponderance is deci- 
dedly in favour of its stimulant properties, and with such an impression 
it is employed." It is this belief, as well as the want of knowledge of 
the essential difference in the action of narcotics according to the dose, 
that has occasioned opium to be discarded in cases of undue vascular 
and nervous excitement for the removal of which it is admirably adapted. 
Impressed with an unfavourable sentiment towards its use — a sentiment 
derived from authors, and teachers — the young practitioner is apt to 
administer it in inflammatory affections, either in doses so small, that no 
\ sedative effect is induced ; or, in his caution, he strikes the medium 
\ ground between stimulation and sedation. In the former case he wit- 
nesses, perhaps, an aggravation of the excitement, and, in the latter, 
either no effect whatever, or one of aggravation ; and he, therefore, too 
hastily concludes, that the use of opium is, in such cases, inappropriate 
and injudicious. Under these feelings, he never employs it afterwards, 
and yet conceives himself entitled to say, from experience, that opium 
is, in no case, advisable, where inflammation is present.^ 

Such were the views strenuously inculcated when the author com- 
menced the study of medicine ; and many a practitioner of the present 
day, who